Institute Poster Submission Form

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International Association of Marriage and Family Counselors

Northampton Family Counseling Institute

Poster Session Application for University Students

Proposals are due ________________, 2015 for full consideration; proposal received after this date will be consider if space is available.

Presenter:

First Name: _______________________Last Name: __________________________________

Mailing Address _______________________________________________________________

_______________________________________________________________                                                 Include, city, state, zip code

Institution Name: ______________________________________________________________

Degree Program/track:__________________________________________________________

Degree /Credentials Attained: ____________________________________________________

E-Mail Address: _______________________________________________________________

Contact Telephone Number:  ____________________________________________________

 

 

If applicable, co-presenter

First Name: _______________________Last Name: __________________________________

Mailing Address _______________________________________________________________

_______________________________________________________________                                                 Include, city, state, zip code

Institution Name: ______________________________________________________________

Degree Program/track:__________________________________________________________

Degree /Credentials Attained: ____________________________________________________

E-Mail Address: _______________________________________________________________

Contact Telephone Number:  ____________________________________________________


 

Poster Session Abstract Page                                                                                                    This page will be used for the review of the Poster Proposal to determine acceptance.  Incomplete submissions will not be considered.

Poster Session Title: _____________________________________________________________

Program Description (20-30 words max: to be used in the Conference Program:

 

 

 

 

 

Program Outline or Summary: Please provide a one-page summary of the proposed poster presentation.

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