Presenter Application - Wisconsin Family Ties

Children Come First Conference

Please fill out this application

Name of Presenter(Required)

First Last

Organization

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Title of your presentation:(Required)

Brief Description of your presentation:(Required)

(to be used in marketing materials, 50 words or less)

Please provide three objectives

Object 1(Required)

Object 2(Required)

Object 3(Required)

Have you presented this workshop elsewhere in Wisconsin in the past year? If so, where and when?

Name/title of co-presenters (if any) and their contact information:

Target audience (check all that apply):(Required)

Parents & Caregivers

Youth

Educators

Mental Health Professionals

Medical Professionals

Juvenile Justice/Corrections

Social Workers

Is there any other information you'd like to share?

To submit, what is 40+30=(Required)

Name

This field is for validation purposes and should be left unchanged.

Wisconsin Family Ties
16 N. Carroll St., Ste. 230
Madison, WI 53703
info@wifamilyties.org
Phone: 608.267.6800
or 800.422.7145
Fax: 608.267.6801

Wisconsin Family Ties
16 N. Carroll St., Ste. 230
Madison, WI 53703

Email: info@wifamilyties.org
Phone: +1 608.267.6800
Toll Free: +1 800.422.7145
Fax: 608.267.6801

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