The National Association for Rural Mental Health
36th Annual Conference Proposal Form
Deadline: October 1, 2009 or until agenda is filled

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

Please indicate the primary role for each presenter: Clinician, Administrator, Junior Researcher (not beyond the post-doc by 7 years), Senior Researcher, Consumer or Other (please specify).

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

First Name:*
Last Name:*
Credentials:
Lead Presenter Role:
If other please specify role:
Address:*
City:*
State:*
Zip:*
Phone Number:*
Email:*
Affiliation:

First Name:
Last Name:
Credentials:
Role:
If other please specify role:

Presentation Format

*Proposal is for: PaperWorkshopPanel/RoundTablePoster
*Focus area(s) addressed:
Rural Behavioral Health Policy and Research
Recovery Focused Rural Behavioral Healthcare
Consumer and Family Voice
Diversity and Culture
Telehealth and Advanced Technology
Rural Behavioral Health Workforce Development
Innovative Practices and Programs for Adults, Children, and Families

*Title of Presentation

*Learning Objectives:

1.
2.
3.
*Short Description of for Conference Program (30 words or less):

*Abstract (500 words or less):

The National Association for Rural Mental Health 36th Annual Conference Proposal Form Deadline: October 1, 2009 or until agenda is filled

Presentation Format

*Learning Objectives:

The National Association for Rural Mental Health
36th Annual Conference Proposal Form
Deadline: October 1, 2009 or until agenda is filled