Presenter Application

The Wisconsin Council on Problem Gambling, Inc. will be hosting its 24th Annual Statewide Compulsive Gambling Awareness Conference.

The Conference will take place March 16-17, 2023.

*The Osthoff Resort in Elkhart Lake, WI*

Deadline to submit Proposal is September 30, 2022

If submitting more than one presentation, please copy and complete an application form for each submission.

Suggested Presentation Areas Include (but are not limited to):

Who Attends This Conference?

Name *

First

Last

Credentials to be used in Conference Brochure *

Organization *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Fax

Honorarium Requested *

Presentation Title to be used in Conference Brochure *

Please indicate the level of your presentation: *

(Please note that this information will be used for CEU applications if presenter and presentation are selected.)

Please write a brief paragraph describing your presentation and at least three (3) goals and objectives for your presentation.

Description of Presentation to be used in Conference Brochure *

Goals and Objectives to be used in Conference Brochure *

Professional Biography to be used in Conference Brochure *

Please add a paragraph of your professional biography.

Signature *

Date *

Message