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Application to Present at the 2012 TX & NM Hospice's Annual Conference
March 16-18

ABOUT T&NMHO
The Texas Hospice Organization, established in 1982, fully merged with the New Mexico Hospice Organization in 1998.  T&NMHO seeks to support its members by offering educational activities, fostering communication and ensuring quality of care through standards and guidelines. 

ABOUT TAPM
Texas Academy of Palliative Medicine (TAPM) is the professional organization of Texas physicians who have an interest in hospice and palliative care.

THE 2012 ANNUAL CONFERENCE
We are excited to announce that we will be holding our Annual Convention at the La Fonda Hotel, Santa Fe, NM on March 16-18, 2012 and we would like to invite you to join us in our celebration of our 31st Conference. We are expecting over 500 professionals in attendance again this year.

PROPOSED TOPICS
Participants are invited to respond to this year's Call for Presentations with a wide range of proposals.  Emphasis is placed both on skills-based teaching workshops, clinical research and interdisciplinary team and health systems-related issues affecting hospice care and End-of-Life issues.

Innovative approaches to hospice care for all terminally ill people are encouraged and welcomed.  Interdisciplinary team proposals and joint presentations by more than one hospice are acceptable.

CONTENT AREAS
To balance the program, we are suggesting that presentations be in the following areas:

  • Clinical/Psychosocial:  Involving all aspects of patient/family care
  • Program Development:  Implementation of hospice programs
  • Management:  Administration of hospice programs

RECORDING
Unless the presenter specifically marks "disagree" on the Permission to Tape portions of the application, the submission of a proposal for the conference will serve as permission to record the presentation and the subsequent sale of the recordings and use of the presentations for on-line training.

PRESENTATION LEVELS
Applicants must select an accurate knowledge level for their intended audience.
• Beginning:  For people with a basic knowledge in a subject area
• Intermediate:  For those having a working knowledge in an area
• Advanced:  Presenter and audience both are knowledgeable and able to discuss the subject matter thoroughly
• General:  Relevant to all participants

Specifying levels assists participants in their selections and improves the presenter's evaluations.

PRESENTATION FORMATS
Workshops are scheduled for 60 minute sessions.  Proposals must be submitted according to the recommended format, including CEU information.  Only those proposals, which include all requested items in computer typed format, will be considered.  (All items on the checklist must be included.)

DEADLINE
Proposals will be accepted by on-line submission,fax or email until 5 p.m., October 14, 2011.  Proposals received after that date and time may not be considered.

SCREENING AND NOTIFICATION
A panel of health professionals representative of an interdisciplinary team will screen the proposals.  Presenters selected will be notified of acceptance by Email not later than January 30, 2012.

REGISTRATION FEES
A $100.00 reduction of conference registration fees will be granted to the two primary presenters in each session.  (All other presenters in that session will be authorized a $50 reduction in fees.)  All communications regarding the proposed session will be directed to the primary presenter.

WHAT TO INCLUDE IN PROPOSALS
To submit a proposal, complete this on-line form and fax or email the following items to the:  Texas & New Mexico Hospice Organization, P.O. Box 1525, Austin, TX 78767   FAX (512) 454-1248. To be considered, proposals must be typed and include all of the following items:

  • A Biographical Data Form with date of April 2010 in right hand corner.
  • A hand signed Presenter Conflict Disclosure Declaration (signed in both signature areas)
  • Education Documentation Form, including PURPOSE of the presentation, with 2 - 4 objectives, etc..  PURPOSE should indicate how the health care professional will use the information in his/her practice and does not use the word 'understand'.
TITLE OF PRESENTATION:
NAME OF PRIMARY PRESENTER:
JOB TITLE:
NAME OF ORGANIZATION :
MAILING ADDRESS:
CITY, STATE, ZIP:
PHONE NUMBER:
EMAIL ADDRESS:
OTHER PRESENTER(S) NAME(S):

JOB TITLE OTHER PRESENTER:



Write 1-3 (150 Characters Max) sentences that describe your presentation (this will go on the brochure and all printed material):

Intended Audiences:       

 

Nurses Volunteers

Physicians

Hospice Aides

Chaplains

Office/Clerical

Social Workers

Administrators

Counselors

Others

Bereavement

All

Type of Presentation:

Audience Level:

Workshop

Beginning

Research

Intermediate

 

Advanced

 

General

AV Needs:   Each room will be set up with podium, microphone, laptop, LCD projector and projector screen. Please list any additional AV needs you have?

Within 72 hours of completing this application, please download, fill out and return the following forms to Brandie Baker at: bbaker@txnmhospice.org or Fax to:  (512) 454-1548 or by mail TX & NM Hospice Organization, P.O. Box 1525, Austin, TX  78767

CONSENT TO TAPE PRESENTATION: 
AGREE  
DISAGREE  
I am the primary presenter and I attest that all the information and consents on this on-line presentation application are true to the best of my knowledge (Please initial in box):