Your Name *

Organization *

Email *

Phone Number *

Mailing Address *

Brief Biography *

Please include a one paragraph (50 words or less) biographical sketch stating credentials and current job title for the presenter.

Please indicate your organization's membership status with LeadingAge Kansas. *

Provider Member

Associate Member/Partner

Not a member of LeadingAge Kansas

Have you presented for LeadingAge Kansas before? *

Yes

No

Have you ever presented for LeadingAge in a different state? *

Yes

No

In the last two years, have you presented this session to any other aging services groups in Kansas *

Yes

No

If so, where have you presented and when? *

Title of Proposed Presentation *

This session would be ideally presented as a *

Conference General Session

Conference Breakout Session

Virtual Webinar or Session

Keynote

Other (asynch, consultation, etc.)

List speaker(s) - Please include Name, Title, and Employer *

Please provide a one paragraph summary of your presentation. *

Engagement Strategy *

For 2027, our education committee is looking for presentations that utilize interactive, engaging, and innovative teaching methods. To be considered, we strongly encourage presentations to include interactive elements, like case studies. If you need support developing these elements, our team is happy to help.

Please briefly describe the engagement methods you plan to use in this session. 

Compensation *

LeadingAge Kansas is committed to making high-quality education accessible to those who need it most—often at little to no cost. We’re able to do this because of the generosity and expertise of professionals and members who share their knowledge to strengthen aging services across Kansas.

Would you consider donating your time and expertise to help advance the field of aging services? By sharing your experience and knowledge, you can help equip others with valuable insights, practical tools, and resources that ultimately benefit older adults and the communities that serve them.

Yes

No

Signature *

I/We understand the intent of this presentation is educational in nature and that promoting a company, service or product during the presentation is prohibited. I/We further understand if selected for an in-person presentation, I/we may be asked to present the session multiple times during the day. If you agree to the above, please type your name and the date.