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Presenter Agreement

Please complete this form by August 30, 2019 so that we can adequately prepare for your presentation.

Thank you

(* Denotes Required Fields)

Presenter Information

Name of lead presenter: *
Email *
I have reviewed the presenter requirements 
Corrections to title (from original submission)
Corrections to speaker name or credentials
Any additional equipment required. Please indicate if you aren't bringing your own laptop.
Presenters attending the entire conference, using the $200 voucher
Presenter 1
Presenter 2
Presenter 3
Presenter 4

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APTA CT PO Box 459
Tolland, CT 06084
(857) 702-9915