Call for Presentation Proposals

2008 Annual Meeting
Camp Nurse Symposium and Seminar
10 - 13 April 2008 - Pheasant Run Resort, St. Charles, IL

Explore the Unexpected:
Expand Your Camp Nursing Knowledge

Limited technology, unique diagnoses and care plans, GLBT health needs, emerging diseases, “hovering” parents – and more!

Presentation Proposal Form

Submit this form and a completed Presenter’s Biographical Data section to ACN for each Presentation Proposal Submitted.

Educational Activity Plan

Title of Educational Activity:

Name of Presenter(s):

Purpose: How does this proposed activity or session support the Symposium’s purpose statement?

Length of the Presentation:

45 Minute Session
60 Minute Session
90 Minute Session

Audio-Visual Needs:

Screen
Overhead Projector
Slide Projector
Powerpoint Projector
Flip Chart

Complete this grid (below) based on your planned educational activity. This assumes the presenter listed above delivers the content described below. If that differs, list the name of the presenter used.

By the end of this section, the learner will be able to (insert behavioral objective):	Outline the content that supports this behavioral learning objective:	Time (minutes):


Teaching-Learning Strategies Used:	Delivery Method:	Resources and Materials Used:
Lecture Discussion Mapping Group Work Reflection Demonstration Learner-Directed Action Other	Face-to-Face Written Material (note sheet, book, journal, etc.) Video Audio Web-based Other	Handouts References AV equipment Lab equipment Simulation Equipment Other


By the end of this section, the learner will be able to (insert behavioral objective):	Outline the content that supports this behavioral learning objective:	Time (minutes):


Teaching-Learning Strategies Used:	Delivery Method:	Resources and Materials Used:
Lecture Discussion Mapping Group Work Reflection Demonstration Learner-Directed Action Other	Face-to-Face Written Material (note sheet, book, journal, etc.) Video Audio Web-based Other	Handouts References AV equipment Lab equipment Simulation Equipment Other


By the end of this section, the learner will be able to (insert behavioral objective):	Outline the content that supports this behavioral learning objective:	Time (minutes):


Teaching-Learning Strategies Used:	Delivery Method:	Resources and Materials Used:
Lecture Discussion Mapping Group Work Reflection Demonstration Learner-Directed Action Other	Face-to-Face Written Material (note sheet, book, journal, etc.) Video Audio Web-based Other	Handouts References AV equipment Lab equipment Simulation Equipment Other

What evaluation method will be used to evaluate this activity? Check all that apply.

Evaluation form
Post-test
Structured interview
Observation of performed skill

What evaluation category is most appropriate for this activity?

Learner satisfaction
Knowledge
Skill
Attitude change
Change in practice, performance
Relationship of changed practice to quality of service

Biographical Data

Check all that apply:

I am an activity planner representing
      content expertise,
      target audience,
      and/or adherence to ANCC COA/WNA CEAP criteria.
I am a Content Expert/Presenter

Name & Degrees:

Address:

City:

State/Province:

Postal Code:

Country:

E-mail Address:

Phone Number:

Present Position (title):

Employer & Location:

Education: Include basic preparation through highest degree held:

Degree:
Institution (Name, City, State):
Major area of study:
Year Degree Awarded:

Briefly describe your experience or area of expertise (including publications, presentations, and/or CE activities) related to your involvement as a content expert/presenter or activity planner:

Conflict of Interest Statement -- All disclosed information must be shared with the audience on program handouts and/or via audiovisual presentation.

Do you have a relevant financial relationship(s) with an entity with a commercial interest?

No
Yes (if "Yes" please complete describe below)

Source of Relevant Financial Support	Nature of Relevant Financial Relationship (list what was received and for what purpose)

Is off-label use of a drug or product addressed in this presentation?

No
Yes
If YES, you must disclose this information during your presentation. How will you do this?
    Verbal statement during the presentation.
    Information provided on handouts
    Information provided in audiovisuals.
    Other:

Indicate your understanding of and willingness to comply with each statement below by checking the appropriate box. If you have questions regarding your ability to comply, contact the Association of Camp Nurses at 218-586-2633.

Agree
Disagree

I have disclosed to the Association of Camp Nurses (ACN) all relevant financial relationships and this information will be disclosed to the learners verbally and in writing.

Agree
Disagree

The content and/or presentation of the information with which I am involved will promote quality or improvements in healthcare and will not promote a specific proprietary business interest of a commercial interest. Content for this activity, including any presentation of therapeutic options, will be well-balanced, evidence-based and unbiased.

Agree
Disagree
N/A

I have not and will not accept any honoraria, additional payments or reimbursements beyond that which has been agreed upon directly with the ACN.

Agree
Disagree

I understand that the ACN may need to review my presentation and/or content prior to the activity, and I will provide educational content and resources in advance as requested.

Agree
Disagree

Since I am presenting at a live event, I understand that a CNE monitor may be attending the event to ensure that my presentation is education and not promotional in nature.

Agree
Disagree

If I am providing recommendations involving clinical nursing, they will be based on evidence that is accepted within the profession of nursing as adequate justification for their indications and contraindications in the care of clients. All scientific research referred to, reported or used in support of justification of a client care recommendation will conform to the generally accepted standards of experimental design, date collection and analysis.

Agree
Disagree
N/A

If I am discussing any product use that is off label, I will disclose that the use or indication in question is not currently approved by the EDA for labeling or advertising.

Agree
Disagree
N/A

If I am discussing specific health care products or services, I will use generic names to the extent possible. If I need to use trade names, I will use trade names from several companies when available and not just trade names from any single company.

Agree
Disagree
N/A

If I have been trained or utilized by a commercial entity or its agent as a speaker for any commercial interest, the promotional aspects of that presentation will not be included in any way with this activity. If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principles and methods, and will not promote the commercial interest of the funding company.

Summary Statement

I have carefully read and considered each item on this form and have completed the form to the best of my ability.

Type Name:

Date:

By checking this box, I am providing my electronic signature approving all the information entered above.

Camp Nurse Symposium Information
Symposium’s program schedule
Symposium & Seminar Online Registration - Register online and make payment online or by phone. Registration deadline is 31 March 2008.
Printable Symposium Information & Registration by Postal Mail - Fill out the form on the screen, print it and mail it with payment. Registration deadline is 31 March 2008.

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Call for Presentation Proposals

2008 Annual Meeting Camp Nurse Symposium and Seminar 10 - 13 April 2008 - Pheasant Run Resort, St. Charles, IL

Presentation Proposal Form

2008 Annual Meeting
Camp Nurse Symposium and Seminar
10 - 13 April 2008 - Pheasant Run Resort, St. Charles, IL