DBC Education Session Proposal Form 24-25

Thank you for your desire to share your knowledge with fellow DBC members and others. After the proposal is submitted and evaluated by DBC, a DBC representative will reach out to the individual listed in the contact information question to share details of the proposal's acceptance, acceptance with modifications or denial.

At that time, additional relevant information will be discussed, such as additional needs, honorarium, dates, etc. In the meantime, if there are any questions as you await a response from DBC, please feel free to reach out at dbc@eatright.org

Thank you!

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

RD/DTR Number

What type of proposal are you submitting?*

Webinar, 60 minutesWebinar Series, Two or more webinars at 60 minutes eachMasterclass, 90 to 120 minute session with pre- and post-session workVirtual Workshop, Three to four hour sessionNetworking SessionOther

What number of speakers are you proposing?*

Single SpeakerTwo SpeakersThree Speakers (Panel Discussion)Other

Speaker #1 Name*

First NameLast Name

Speaker #1 Credentials

Speaker #1 Email*

example@example.com

Speaker #1 Phone*

Please enter a valid phone number.

Short speaker bio (#1)*

100 words or less, each

Speaker #2 Name

First NameLast Name

Speaker #2 Credentials

Speaker #2 Email

example@example.com

Speaker #2 Phone

Please enter a valid phone number.

Short speaker bio (#2)

100 words or less, each

Speaker #3 Name

First NameLast Name

Speaker #3 Credentials

Speaker #3 Email

example@example.com

Speaker #3 Phone

Please enter a valid phone number.

Short speaker bio #3

100 words or less, each

Webinar/Session title*

Please provide a webinar description.*

200 words or less

Please list three webinar learning objectives.*

Please list three suggested performance indicators.*

Performance Indicators can be found here: https://bit.ly/3OSup3d

What novel information, idea, or concept does this proposal bring?*

Why do you think DBC members would want to attend this program?*

Program competency level*

NoviceIntermediateAdvancedExpert

In regard to potential presentation dates, how desirable are the following months?*

	Extremely Desirable	Very Desirable	Desirable	Slightly Desirable	Not Desirable
November 2024
December 2024
January 2025
February 2025
March 2025
April 2025
May 2025
June 2025

Has this presentation material been presented to other dietetic groups within the last 12-months?*

Yes, through DPGsYes, through Academy AffiliatesYes, through the AcademyYes, through a non-Academy related dietetic group, publication, etc.No, this presentation material has not been presented to other dietetic groups within the last 12-months

What is your position on potential sponsorship?*

I do not have a sponsor in mind, but I am open to having the webinar sponsoredI do not have a sponsor in mind, and I am NOT open to having the webinar sponsoredI have a sponsor in mind that I can share with DBC to get on board to sponsor the webinarOther

How comfortable are you integrating the following engagement opportunities within your presentation?*

	Extremely Comfortable	Very Comfortable	Comfortable	Slightly Comfortable	Not Comfortable
Polls
Interactive Handouts
Breakout Sessions
Other

Post-webinar, are you willing to also provide a complimenting article for the DBC’s Business Insights newsletter?*

yesno

Are you a DBC member?*

yesno

Comments/Suggestions: