The National Association for Rural Mental Health
45th Annual Conference

From Surviving to Thriving: Embracing Connections

Proposal Form
Deadline: February 1, 2019 or until agenda is filled.

The lead presenter is responsible for forwarding information to co-presenters. All presenters must register for the conference and are responsible for their own registration fees, travel and hotel arrangements and fees.

We will continue to accept proposals for the conference until the agenda is filled.

Lead Presenter

First Name:*  
Last Name:*  
Credentials:
Lead Presenter Role: Choose One Clinician Administrator Junior Researcher (not beyond the post-doc by 7 years) Senior Researcher Consumer Other  
If other please specify role:
Address:*  
City:*  
State:*  
Zip:*  
Phone Number:*  
Email:*    
Organization:

Co-presenter 1

First Name:
Last Name:
Organization:
Credentials:
Role: Choose One Clinician Administrator Junior Researcher (not beyond the post-doc by 7 years) Senior Researcher Consumer Other
If other please specify role:

Co-presenter 2

First Name:
Last Name:
Organization:
Credentials:
Role: Choose One Clinician Administrator Junior Researcher (not beyond the post-doc by 7 years) Senior Researcher Consumer Other
If other please specify role:

Co-presenter 3

First Name:
Last Name:
Organization:
Credentials:
Role: Choose One Clinician Administrator Junior Researcher (not beyond the post-doc by 7 years) Senior Researcher Consumer Other
If other please specify role:

Co-presenter 4

First Name:
Last Name:
Organization:
Credentials:
Role: Choose One Clinician Administrator Junior Researcher (not beyond the post-doc by 7 years) Senior Researcher Consumer Other
If other please specify role:

Presentation Format

*Proposal is for:       Paper
Workshop
Panel/RoundTable
Poster

*Focus area(s) addressed:    
1. Surviving to Thriving
2. Workforce Issues
3. Innovations in Service Delivery
4. Dilemmas in Addressing Trauma
5. Rural and Frontier Workforce Development Strategies
6. Embracing the Reality of Behavioral Health in Rural Communities – Struggles, Responses and Successes
7. Co-Occurring Substance Use Disorders
8. Other topics

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*Title of Presentation (10 words or less)  

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Learning Objectives:

Objective 1.*  


Objective 2.*  


Objective 3.*  

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*Short Description of Session for Conference Program (30 words or less):  

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*Abstract (500 words or less):  

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Presenter Acknowledgement

I understand that as a presenter, I must register for the conference and am responsible for my own registration fees, travel and hotel arrangements and costs.