Lead Presenter Name *

First and Last Name

Institution/Company *

Position Title *

Lead Presenter Email *

Lead Presenter Phone Number *

Lead Presenter Professional Headshot *

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Lead Presenter Professional Bio *

Are their Co-Presenters? *

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Co-Presenter Name *

Institution/Company *

Position Title *

Co-Presenter Email *

Co-Presenter Headshot *

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Co-Presenter Professional Bio *

Presentation Title *

Session Focus Area *

Student Government

Relationship/Community Building

Student Organizations

Leadership Skills and Practices

Time Management

Affinity Groups

Workshop Description *

Workshop Learning Outcomes *

Describe any additional reasonable accommodations or resources required (optional).

Audio/Visual Needs *

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Presentation PPT (Optional)

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Presentation Handout (Optional)

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Additional File (Optional)

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Terms and Publicity Agreements *

I hereby and irrevocably authorize CCCSAA to record this workshop session for the purpose of freely distributing the recording to CCCSAA members. I waive my right to inspect or approve the finished recording.

I hereby also give CCCSAA consent to the use of all digital images, photographs, videoatapes, or film, taken of me and/or recordings made of their voices and/or written extractions, in whole or in part, of such recordings or musical performance representing CCCSAA and/or others with its consent, for the purposes of illustration, advertising, creating derivative works, or publications in any manner. If the stated information is not to be released, please notify CCCSAA in writing.

Further, I hereby hold harmless and forever release and discharge CCCSAA from all claims demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I am at least 18 years of age and competent to contract in my own name. I have read this release and I fully understand the contents, meaning, and impact of this release.

Do you agree with all Terms and Agreements stated above and the information submitted to be true? *

I, the presenter or agency, understand that by submitting this proposal, I/We am/are volunteering to present at the CCCSAA Student Leadership Conference. I will not receive reimbursement for expenses (including transportation, lodging, or meals) and waive all fees/honoraria. This presentation is a voluntary professional service to CCCSAA. As a presenter, I will gain valuable professional exposure to colleagues across California’s 116 community colleges, the opportunity to showcase my expertise, contribute to advancing Student Affairs, and expand my professional network.

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Do all presenters understand, if selected, all presenters will need to be a registered attendee for *

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Name of Person Completing this form? *