This document is a speaker application for a thyroid cancer survivor reunion and celebration of life event held from September 1-8, 2012. It requests applicant information like name, organization, contact details, presentation title, description, learning objectives, and preferred presentation track. The deadline to submit is May 20, 2012 via email. It also lists policies for speakers regarding travel expenses, original work, sales pitches, handout materials, and event registration.

1. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Presenter Name
Presenter Designation
Page | 1
Presenter Job Title
Organization Name
Mailing Address
City
State / Providence
Zip / Postal Code
Country
Telephone
Fax
Email
Website
Blog
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2. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Co-Presenter Name
Co-Presenter Designation
Page | 2
Co-Presenter Job Title
Presentation Title
Session Description
Note: This description will be
used for promotional
purposes and should be a
complete and detailed
description in 75 words or
less that fully describes your
topic content.
Learning Objective 1
Learning Objective 2
Learning Objective 3
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3. Stevie JoEllie’s Cancer Care Fund’s Annual Thyroid Cancer Survivors
Reunion and Celebration of Life Sept. 1st -8th 2012
Speaker/Presentation Application/Proposal
Deadline for Submission: May 20, 2012
Email: steviejoelliescancercarefund@gmail.com
Subject Line: Speaker Proposal
Presentation Track Please choose the category that best fits your
Select Only One presentation topic and target audience.
Page | 3
Thyroid Cancer Patients ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Thyroid Cancer Survivors ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Caregivers and Loved Ones ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
HealthCare Professionals ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Health and Wellness ( ) Pediatric ( ) Adolescent ( ) Young Adult ( ) General
Please review the following SJCCF Speaker and Presenter Policies prior to
submitting your presentation description:
 Stevie JoEllie’s Cancer Care Fund does not pay for travel expenses or speaker fees.
 Stevie JoEllie’s Cancer Care Fund requires that your presentation and materials be your
own original work or have obtained any necessary copyright permissions.
 Stevie JoEllie’s Cancer Care Fund does not allow sales pitches or self promotion in their
presentations. All information is to be presented in a fair and balanced context. Content
should be based upon a relevant topic, concept or idea, not a specific product or service.
 Stevie JoEllie’s Cancer Care Fund requires that if your topic is selected, that all handout
materials be submitted a minimum of 2 weeks before the conference.
 Stevie JoEllie’s Cancer Care Fund asks that you register for the Event if you are planning
on attending beyond your own session.
Signature:______________________________________ Dated:________________________
Printed Name:__________________________________ Title:__________________________
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