Conference Speaker Application–2025 Annual Conference | Indiana Academy of Nutrition & Dietetics

Application for speaker engagement at the 2025 IAND Annual Conference:
“Better Together: Connecting Research, Policy and Practice”
April 10& 11, 2025
Embassy Suites Plainfield Indianapolis Airport, 6089 Clarks Creek Road, Plainfield, IN 46168

Conference Speaker Application - Annual Conference April 2025*

Name(Required)

First Last

Credentials(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-mail Address(Required)

Phone Number(Required)

Website (if applicable)

Applicable Memberships

Academy of Nutrition and Dietetics

Indiana Academy of Nutrition and Dietetics

Other Memberships

Speaker Bio(Required)

To be used for marketing and introduction purposes

Resume or Curriculum Vitae(Required)

Attach resume or curriculum vitae for each speaker.

Max. file size: 25 MB.

Attach Speaker Photo(Required)

Photo will be used for marketing and introduction purposes. Attach photo for each speaker.

Max. file size: 25 MB.

Type of Proposal(Required)

If "Other" proposal type was selected above, please describe.

Proposal for: Select all that apply

Thursday, April 10th: 2025: 2025 IAND Annual Conference

Friday, April 11th: 2025: 2025 IAND Annual Conference

Presentation Title(Required)

Abstract of Presentation Proposal(Required)

Proposed Learning Objectives (minimum of 3)(Required)

Planned activities to engage the audience(Required)

CPEU Learning Level(Required)

Commission for Dietetic Registration (CDR) descriptions

I acknowledge that IAND may record the session for a membership self-study opportunity(Required)

Yes

Requested Honorarium(Required)

Confirmed sources of funding or sponsorship(Required)

Please note source of funding/sponsorship support, if applicable.

Disclosure of Relevant Financial Relationships and Conflict(s) of Interest

Conflict of interest in CPE arises in CPE when individual financial relationships relevant to the CPE content compromise or have the potential to compromise professional judgement and/or impart bias into CPE content. All individuals who influence, control, contribute to, or present CPE content must disclose relevant financial relationships and conflicts of interest. Individuals must disclose all financial relationships within the prior 24 months, regardless of the amount.

Conflict of Interest(Required)

In the past 24 months, I have not had any financial relationships with companies or organizations.

I have conflicts or potential conflicts as described below.

Declaration of conflict of interest

Examples of “nature of financial relationship (individual’s role with company or organization)”: employee, researcher, consultant, advisor, speaker, independent contractor (including contracted research), royalties or patent beneficiary, executive and person with ownership interest. Use the "+" to add additional lines as needed.

Company or organization with which individual has a financial relationship

Nature of financial relationship (individual’s role with company or organization

Conflict of Interest Agreement(Required)

I attest that the above information is correct as of this date of submission