Presenter Information - Minnesota Division of the IAI

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PLEASE NOTE: For the 2021 Conference, Friday is completely full. However, there are still time slots available Wednesday afternoon and the full day on Thursday. Thank you!

Course Presenters: Please complete all required fields and submit this registration form. This information is needed for internal use and for applying to the MN POST Board and the MN ABMDI Board for course credits. If presenting more than one course during any given conference, please include all course titles and outlines in the fields provided below.

Thank you!

Presenter(s) Registration Form

* Indicates required field

Name: *

First

Last

Employer: *

Employer Address: *

Line 1

Line 2

City

State

Zip Code

Country

Preferred Email Address: *

Preferred phone number (please include dashes): *

Are you a member of the MN Division of the IAI? *

Yes No

Would you like to become a member? *

Already a member Yes No

If you wish to become a member, please complete the form found by clicking here and submit it to the Secretary/Treasurer no later than Thursday morning during the Conference. If you join at the Conference, the application fee is waived as well as dues for your first full year of membership. Thank you!

Official Title: *

IAI certifications, if any: *

Complete below fields
regarding Course 2 (if applicable):

Upload your CV or Bio here. *

Max file size: 20MB

Upload any additional files here. *

Max file size: 20MB

Upload any additional files here. *

Max file size: 20MB

Upload any additional files here. *

Max file size: 20MB

Upload any additional files here. *

Max file size: 20MB

Upload any additional files here. *

Max file size: 20MB

Special note: Please email the Secretary/Treasurer directly to ask for information regarding travel expense reimbursements.

**If there are co-presenters,
please continue by inputting information below. Once finished,
submit the form by clicking the 'Submit Form' button at the bottom of the page.**

**If there are no co-presenters,
please scroll to the bottom and
submit the form by clicking the button.**

Do you have co-presenters? Please list them here.

CO-PRESENTER #1

Co-presenter #1 Name: *

First

Last

Co-presenter # 1 Employer: *

Co-presenter #1 Employer Address: *

Line 1

Line 2

City

State

Zip Code

Country

Co-presenter #1 Preferred Email Address: *

Co-presenter #1 Preferred Phone Number (please include dashes): *

Co-presenter #1, upload your CV or Bio here. *

Max file size: 20MB

Co-presenter #1, please make your own hotel reservation(s) via information found on our homepage. Be sure to view the reimbursement policy by rolling over the question mark. Will you require hotel reimbursement? *

Yes No

Co-presenter #1, are you a member of the MN Division of the IAI? *

Yes No

Co-presenter #1, would you like to become a member? *

Yes No Already a member

If you wish to become a member, please complete the form found by clicking here and submit it to the Secretary/Treasurer no later than Thursday morning during the Conference. If you join at the Conference, the application fee is waived as well as dues for your first full year of membership. Thank you!

Co-presenter #1 Official Title: *

Co-presenter #1 IAI Certifications (if any): *

Co-presenter #1, will you attend the banquet on Thursday night? Dinner is on us! *

Yes No

Co-presenter #1, will you attend any or all other presentations during the conference? *

Yes, all days Yes, Thursday only Yes, Friday only No

Co-presenter #1, if attending other presentations, do you require an attendance certificate? *

Yes No N/A

Co-presenter #1, for attendance certificate, enter POST number (if applicable): *

Co-presenter #1, for attendance certificate, enter ABMDI number (if applicable): *

CO-PRESENTER #2

Co-presenter #2 Name: *

First

Last

Co-presenter #2, upload your CV or Bio here. *

Max file size: 20MB

Co-presenter #2 Employer: *

Co-presenter #2 Employer Address: *

Line 1

Line 2

City

State

Zip Code

Country

Co-presenter #2, please make your own hotel reservation(s) via information found on our homepage. Be sure to view the reimbursement policy by rolling over the question mark. Will you require hotel reimbursement? *

Yes No

Co-presenter #2, are you a member of the MN Division of the IAI? *

Yes No

Co-presenter #2, would you like to become a member? *

Yes No Already a member

Co-presenter #2 Preferred Email Address: *

Co-presenter #2 Preferred Phone Number (please include dashes): *

Co-presenter #2 Official Title: *

If you wish to become a member, please complete the form found by clicking here and submit it to the Secretary/Treasurer no later than Thursday morning during the Conference. If you join at the Conference, the application fee is waived as well as dues for your first full year of membership. Thank you!

Co-presenter #2 IAI Certifications (if any): *

Co-presenter #2, will you attend the banquet on Thursday night? Dinner is on us! *

Yes No

Co-presenter #2, will you attend any or all other presentations during the conference? *

Yes, all days Yes, Thursday only Yes, Friday only No

Co-presenter #2, if attending other presentations, do you require an attendance certificate? *

Yes No N/A

Co-presenter #2, for attendance certificate, enter POST number (if applicable): *

Co-presenter #2, for attendance certificate, enter ABMDI number (if applicable): *

CO-PRESENTER #3

Co-presenter #3 Name: *

First

Last

Co-presenter #3 Employer: *

Co-presenter #3 Employer Address: *

Line 1

Line 2

City

State

Zip Code

Country

Co-presenter #3, upload your CV or Bio here. *

Max file size: 20MB

Co-presenter #3, please make your own hotel reservation(s) via information found on our homepage. Be sure to view the reimbursement policy by rolling over the question mark. Will you require hotel reimbursement? *

Yes No

Co-presenter #3, are you a member of the MN Division of the IAI? *

Yes No

Co-presenter #3, would you like to become a member? *

Yes No Already a member

Co-presenter #3 Preferred Email Address: *

Co-presenter #3 Preferred Phone Number (please include dashes): *

Co-presenter #3 Official Title: *

If you wish to become a member, please complete the form found by clicking here and submit it to the Secretary/Treasurer no later than Thursday morning during the Conference. If you join at the Conference, the application fee is waived as well as dues for your first full year of membership. Thank you!

Co-presenter #3 IAI Certifications (if any): *

Co-presenter #3, will you attend the banquet on Thursday night? Dinner is on us! *

Yes No

Co-presenter #3, will you attend any or all other presentations during the conference? *

Yes, all days Yes, Thursday only Yes, Friday only No

Co-presenter #3, if attending other presentations, do you require an attendance certificate? *

Yes No N/A

Co-presenter #3, for attendance certificate, enter POST number (if applicable): *

Co-presenter #3, for attendance certificate, enter ABMDI number (if applicable): *

CO-PRESENTER #4

Co-presenter #4 Name: *

First

Last

Co-presenter #4, upload your CV or Bio here. *

Max file size: 20MB

Co-presenter #4 Employer: *

Co-presenter #4 Employer Address: *

Line 1

Line 2

City

State

Zip Code

Country

Co-presenter #4 Preferred Email Address: *

Co-presenter #4 Preferred Phone Number (please include dashes): *

Co-presenter #4, please make your own hotel reservation(s) via information found on our homepage. Be sure to view the reimbursement policy by rolling over the question mark. Will you require hotel reimbursement? *

Yes No

Co-presenter #4, are you a member of the MN Division of the IAI? *

Yes No

Co-presenter #4, would you like to become a member? *

Yes No Already a member

If you wish to become a member, please complete the form found by clicking here and submit it to the Secretary/Treasurer no later than Thursday morning during the Conference. If you join at the Conference, the application fee is waived as well as dues for your first full year of membership. Thank you!

Co-presenter #4 Official Title: *

Co-presenter #4 IAI Certifications (if any): *

Co-presenter #4, will you attend the banquet on Thursday night? Dinner is on us! *

Yes No

Co-presenter #4, will you attend any or all other presentations during the conference? *

Yes, all days Yes, Thursday only Yes, Friday only No

Co-presenter #4, if attending other presentations, do you require an attendance certificate? *

Yes No N/A

Co-presenter #4, for attendance certificate, enter POST number (if applicable): *

Co-presenter #4, for attendance certificate, enter ABMDI number (if applicable): *

Submit Form