International Council on Active Aging®

Pronoun

She/Her/Hers

He/Him/His

They/Them/Theirs

Prefer to not answer

Please check here to add the second presenter information

Please check here to add the third presenter information

Write a title that describes the content of the session. Keep it simple, concise and engaging.The title can be no longer than 10 words.

Write a description detailing what attendees will learn at your session. Be as specific as possible with session outcomes. What problem or challenge can professionals solve by attending? Will they practice a technique or movement? What is innovative or special about your take on the topic?Limit to 150 words

List three objectives, which are required to obtain CEUs for our delegates. What practical techniques or skills or action plans will they walk away with? Attendees will be able to (e.g., list, analyze, develop, demonstrate, modify). List what individuals will be able to do, not what you plan to teach them. By the end of this session, attendees will be able to

1

2

3

How will ICAA delegates implement your session content?

After the conference, how will attendees promote their programs, share information, launch a new initiative or change the way they perform their jobs? How will they follow up on the learning objectives?

Additional information for sessions referencing technologies

Name the specific technologies, brands, platforms and data tools that will be presented in the session. (100 words)

Can attendees implement the session content if they do not have the referenced technologies?

Yes

No

Equipment requirements for activity-based sessions

If your session requires equipment, please detail the type and quantity preferred along with contact information for the company that will supply the equipment you need.

Primary presenter biography

Provide a biography that shows your expertise and experience in the topic so attendees see how your background qualifies you to present this topic.(150 words)

Second presenter biography

Provide a biography that shows your expertise and experience in the topic so attendees see how your background qualifies you to present this topic.(150 words)

Third presenter biography

Provide a biography that shows your expertise and experience in the topic so attendees see how your background qualifies you to present this topic.(150 words)

Primary presenter education credentials

Certification agencies require specific details of each presenter’s education and credential. We need to know exactly how your degree is abbreviated, e.g, BS or BSc or BA, Phd or EdD, etc. For certifications indicate your renewal and expiry date. If you have neither, please check below.

I do not have a degree or certification

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Degree abbreviation

Degree, complete name

Year received

College/University awarding the degree

Certification or other credential. Which certification do you hold from the following agencies? Please list the single credential most relevant to the topic. These are the agencies where ICAA will submit session descriptions.
ACE. American Council on Exercise
ACSM. American College of Sports Medicine
AFAA. Athletics and Fitness Association of America
NAB. National Association of Long Term Care Boards
NAFC. National Association for Fitness Certification
NASM. National Academy of Sports Medicine
NCCAP. National Certification Council for Activity Professionals
NCCDP. National Council of Certified Dementia Practitioners
NSCA. National Strength and Conditioning Association

Certification (complete name)

Certifying agency awarding the credential

Date renewed

Expiration date

Second presenter education credentials

Certification agencies require specific details of each presenter’s education and credential. We need to know exactly how your degree is abbreviated, e.g, BS or BSc or BA, Phd or EdD, etc. For certifications indicate your renewal and expiry date. If you have neither, please check below.

I do not have a degree or certification

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Degree abbreviation

Degree, complete name

Year received

College/University awarding the degree

Certification or other credential. Which certification do you hold from the following agencies? Please list the single credential most relevant to the topic. These are the agencies where ICAA will submit session descriptions.
ACE. American Council on Exercise
ACSM. American College of Sports Medicine
AFAA. Athletics and Fitness Association of America
NAB. National Association of Long Term Care Boards
NAFC. National Association for Fitness Certification
NASM. National Academy of Sports Medicine
NCCAP. National Certification Council for Activity Professionals
NCCDP. National Council of Certified Dementia Practitioners
NSCA. National Strength and Conditioning Association

Certification (complete name)

Certifying agency awarding the credential

Date renewed

Expiration date

Third presenter education credentials

Certification agencies require specific details of each presenter’s education and credential. We need to know exactly how your degree is abbreviated, e.g, BS or BSc or BA, Phd or EdD, etc. For certifications indicate your renewal and expiry date. If you have neither, please check below.

I do not have a degree or certification

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Degree abbreviation

Degree, complete name

Year received

College/University awarding the degree

Certification or other credential. Which certification do you hold from the following agencies? Please list the single credential most relevant to the topic. These are the agencies where ICAA will submit session descriptions.
ACE. American Council on Exercise
ACSM. American College of Sports Medicine
AFAA. Athletics and Fitness Association of America
NAB. National Association of Long Term Care Boards
NAFC. National Association for Fitness Certification
NASM. National Academy of Sports Medicine
NCCAP. National Certification Council for Activity Professionals
NCCDP. National Council of Certified Dementia Practitioners
NSCA. National Strength and Conditioning Association

Certification (complete name)

Certifying agency awarding the credential

Date renewed

Expiration date

Data projector, screen, wireless microphones are provided. Presenters provide OWN laptop and remote control for changing slides. Due to costs, internet connection is NOT available. If you order ANY audiovisual on site, including laptops, you will be invoiced for the cost.

all expenses

WILL NOT

my own laptop computer and slide changer

Second Presenter Acknowledgement

all expenses

WILL NOT

my own laptop computer and slide changer

Third Presenter Acknowledgement

all expenses

WILL NOT

my own laptop computer and slide changer

ICAA Conference

Application form

Primary presenter information

Second presenter information

Third presenter information

Session title

Abstract/Session description

Learning objectives

How will ICAA delegates implement your session content?

Additional information for sessions referencing technologies

Equipment requirements for activity-based sessions

Primary presenter biography

Second presenter biography

Third presenter biography

Primary presenter education credentials

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Second presenter education credentials

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Third presenter education credentials

Academic degree. Relevant to the topic you are proposing, what is the one highest degree you hold at the college or university level?

Audiovisual requirements

Primary Presenter Acknowledgement

Second Presenter Acknowledgement

Third Presenter Acknowledgement

icaa 100 members