Spring Speaker Forms

Spring Speaker Forms

Form is used by the participant speakers in the workshop. Register all of them easily and in an orderly way according to expertise. Form Preview
  • 2017 Speaker Form

  • Please complete this form, attach (1) the Speaker Information Form or your resume/CV, (2) Workshop Description, and (3) Workshop Bibliography, where indicated, and submit.

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  • Hotel Reservations

  • All hotel accommodations will be made at THE TOWN AND COUNTRY SAN DIEGO and will be coordinated through CWA.  PLEASE DO NOT CONTACT THE TOWN & COUNTRY DIRECTLY FOR RESERVATIONS.  If you have made arrangements with CWA to cover your hotel accommodations, only your room and tax for ONE night will be covered unless previously approved. You will be required to provide a credit card at check-in for any incidentals.   Hotel confirmations will be sent via email once hotel rooms are booked.   

  •  -  - Pick a Date
  •  -  - Pick a Date
  • We will do our best to accommodate any special requests, if possible, with the hotel.

  • Audio Visual Request

  • All AV requests must be submitted by March 10, 2017. or we may not be able to accommodate your request.

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  • Audio Visual Equipment:

    Each workshop session will include a standard AV package which includes the following equipment:

    • Speaker’s Podium
    • One Wireless Microphone
    • Laptop computer with DVD/CD capability
    • Projector, sound, and screen

    Please bring your presentation on a memory (USB) stick to Speaker Registration for preloading of your presentation.  No personal computer needed.

  • Speaker and Workshop Form Uploads

  • Upload a File
  • Speaker Disclosure/Conflict of Interest Declaration/Liability Statement

  • It is the policy of the California WIC Association to make best efforts to insure balance, independence, objectivity, and scientific rigor in all programs which qualify for continuing education units.

    Consequently, all persons participating in any program for which continuing education units are awarded are expected to disclose to the program audience any real or apparent affiliations that may have a bearing in the subject matter of their presentation.  Any relevant information provided on the Declaration will be disclosed to the program audience in written conference materials.  Such affiliations include, but are not limited to:

    • manufacturers of food, food ingredients, food supplements, vitamins, herbs
    • restaurant or fast food companies
    • manufacturers of infant artificial feeding products
    • pharmaceutical companies
    • manufacturers or marketers of biomedical devices, including any devices intended to be used during breastfeeding/lactation or for weight control
    • any other persons or entities related to the subject matter of the presentation topic or the general topics of the program as a whole.

    The intent of this policy is not to prevent a speaker from making a presentation. It is merely intended that any potential conflict of interest shall be identified openly so that listeners may form their own judgments about the presentation with the full disclosure of pertinent facts. It remains for the audience to determine whether the speaker’s outside interests may reflect a possible bias in either the exposition or the conclusions presented.

  • By submitting this form, you are declaring that:

  • Liability Statement
    By submitting this form, I agree to indemnify and hold harmless the California WIC Association, its successors, board, officers, employees and agents from any and all liability for injuries and damages which may arise as a result of my participation in any and all Spring Conference 2017 activities.  I am aware that the California WIC Association does not carry medical insurance for participants in this activity.  I will additionally permit the use of my name and pictures in printed and non-printed formats such as pamphlets, newsletters, newspapers, magazines, etc.

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