Presenter Course Proposal and Agreement
Thank you for your interest in presenting at the 2022 Telemental Health Summit to be held from March 21st-23rd.  The submission of your proposal does not guarantee its acceptance.  TCI's Summit Committee will review all proposals and inform you of their decision.  This form is also an agreement between the Telehealth Certification Institute LLC, a U.S. corporation with its principal office located at  125 N. Main, Suite 500 #348, Blacksburg, VA 24060, and you (Presenter) listed below.
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Engagement
TELEHEALTH CERTIFICATION INSTITUTE LLC desires to retain the services of Presenter to create and present a course. The course will be presented via a live webinar and recorded to be sold as an online self study course.  Presenter desires to render services to TELEHEALTH CERTIFICATION INSTITUTE LLC, consistent with the terms of this Agreement.
Submission Dates
This proposal must be submitted by November 30th, 2021 and the course content (slides or text that is sufficient for review, and post-test questions) must be submitted by December 31st, 2021.
Presenter Name + credentials *
Email Address *
Phone number *
Personal mailing address (Street, City, State) *
Place of work *
Job title (as you want it to appear) *
Link to your personal business website or LinkedIn
Link to your organization's website
Professional bio (as you want it to read in any publications) *
Please email a headshot(s) and resume (or curriculum vitae) of each presenter to support@telehealthcertificationinstitute.com. ***Please ensure headshots are a professional image of a medium/ large file size, that is not closely cropped (allowing for modification on graphics).*** *
Will there be other presenters other than yourself for this course? *
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