You can always press Enter⏎ to continue
New Mexico Symposium on Health Speaker Registration

New Mexico Symposium on Health Speaker Registration

  • 1

    Thank you for your interest in presenting at the Summit! This form collects all the necessary information to support CEU accreditation, ensure accurate reporting, and help us provide attendees with clear, professional session descriptions. 

    This is a detailed form so please complete only when you have time to complete accurately and with as much detail requested. The estimated time to complete this form is 20–45 minutes, depending on your role and whether you have all your materials ready to upload.

    If you are registering as a Lead Presenter, you’ll be asked to provide both personal information and detailed session information.

    If you are regsitering as a Co-Presenter, you only need to submit the title of your session the name of the lead presenter and your personal details. 

    Presenter Information

    All presenters should have the following items ready to upload:

    • Resume or CV (required for CEUs)
    • Short Bio (required for CEU's and listed in your speaker profile)
    • Headshot (professional photo for program/marketing)

    Session Information 

    Lead Presenters will need to provide the following materials:

    • Session Title
    • Session Summary (a short paragraph for the program and attendees)
    • Learning Objectives (3–5 clear, action-oriented statements)
    • Knowledge Check Questions (3–5 multiple choice, true/false, or short answer)
    • Presentation Slides (optional at this stage — can be uploaded later)
    • Materials for Attendees (optional at this stage — can be uploaded later)

    Co-Presenters will need to provide the following information:

    • Session Title
    • Name of the Lead Presenter

     Collecting this information up front allows us to:

    • Meet CEU accreditation standards
    • Support funding and reporting requirements
    • Clearly and accurately promote your session to attendees
    • Streamline travel, lodging, and logistical planning
    • Manage conference expenses in order to deliver maximum impact for participants
    • Minimize follow-up emails — saving you time!

    We appreciate you taking the time to complete this form thoroughly. Your detailed input helps make the conference smoother, more effective, and more enjoyable for everyone involved!

    Press
    Enter
  • 2
    Press
    Enter
  • 3
    Press
    Enter
  • 4
    Press
    Enter
  • 5
    Press
    Enter
  • 6
    This will be used to determine your eligibility for travel and lodging coverage. Speakers traveling more than 60 miles one way to the conference are eligible for reimbursement.
    Please Select
    • Please Select
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curaçao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • United States
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 7
    Press
    Enter
  • 8
    PhD, LMSW, LCSW, RN, etc.
    Press
    Enter
  • 9
    CEU accrediting bodies requires a résumé to verify that presenters meet qualification requirements.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 10
    CEU accrediting bodies requires a brief bio to document the presenter’s professional background and expertise.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 11
    Headshots are optional and used only for event promotion and presenter recognition.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 12
    Please select all that apply.
    Press
    Enter
  • 13
    Press
    Enter
  • 14
    Press
    Enter
  • 15
    Press
    Enter
  • 16
    Press
    Enter
  • 17
    Please note that ALL co-presenters must also complete this form separate from your submission.
    Press
    Enter
  • 18
    Press
    Enter
  • 19
    Press
    Enter
  • 20
    Press
    Enter
  • 21
    Press
    Enter
  • 22
    Press
    Enter
  • 23
    Press
    Enter
  • 24
    Press
    Enter
  • 25
    Press
    Enter
  • 26
    Press
    Enter
  • 27
    Press
    Enter
  • 28
    Press
    Enter
  • 29
    Press
    Enter
  • 30
    A session description is required for review by both the selection committee and the CEU accrediting body to assess content relevance, learning objectives, and educational value.
    • Huge
    • Large
    • Normal
    • Small
    Ok
    quoteCreated with Sketch.
    Ok
    Press
    Enter
  • 31

    Learning Objectives

    Provide 3-5 clear, measurable learning objectives that outline the intended knowledge or skills participants will gain. These are used for both session review and CEU approval.

    Objectives should be clear, measurable, and action-oriented (e.g., “Identify three strategies…” or “Explain how to…”).

    Press
    Enter
  • 32
    Press
    Enter
  • 33
    Press
    Enter
  • 34
    Press
    Enter
  • 35
    Press
    Enter
  • 36
    Press
    Enter
  • 37

    Knowledge Checks

    CEU accrediting bodies and the selection committee require 3 - 5 knowledge checks to ensure the session includes measurable participant engagement and learning assessment.

    Sample questions  that reflect the main takeaways from your session. These will help reinforce learning and engage participants.

    True or False, Multiple-Choice or fill in the blank are accepted options.

    Knowledge checks are required for sessions to be eligible for continuing education units.

    Press
    Enter
  • 38
    Press
    Enter
  • 39
    Press
    Enter
  • 40
    Press
    Enter
  • 41
    Press
    Enter
  • 42
    If they’re not ready yet, no worries — you’ll have the opportunity to upload them closer to the Summit.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 43
    Please note that we do not print materials to distribute to attendees. These files will only be available electronically.
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 44

    Constellation Consulting’s standard practice is to submit all selected presentations for CEU approval approximately 90 days prior to conference registration opening.

    Once a session has been submitted for approval, no changes may be made to presentation materials, session times, titles, or listed presenters without jeopardizing CEU approval. Loss of CEUs can significantly impact attendance in your session, so it is essential that all information you provide is accurate and final.

    Please ensure that you provide all co-presenter names, titles, and contact information before submitting your proposal.

    Press
    Enter
  • 45
    Powered by Jotform SignClear
    Press
    Enter
  • 46
    Please let us know your preference for room set up
    Press
    Enter
  • 47
    The standard A/V setup includes a laptop, podium, microphone, screen, projector, and sound system. We will make every effort to accommodate additional requests, but availability cannot be guaranteed.
    Press
    Enter
  • 48
    Press
    Enter
  • 49

    Constellation Consulting strives to provide fair and equitable honorariums to presenters at the New Mexico Symposium on Health.

    Honorariums are provided; however, final amounts are determined after the conference budget is fully finalized to ensure that funds are allocated responsibly and equitably.

    We deeply value the contributions of all presenters—general session, breakout, and workshop facilitators alike—and appreciate your understanding as we work to balance event needs while recognizing the important role each presenter plays in the success of the Symposium.

    • A current W-9 form must be on file in order for us to issue an Honorarium.
    • Honorarium payments will be processed via bill.com within 45 days after the closing of the conference.  Constellation Consulting, LLC will invite you to open a free bill.com account and/or connect with your current bill.com account. This invitation will go out at the close of the conference along with a reimbursement form for each of you to complete. 
    • Speakers are responsible for creating and maintaining an up-to-date bill.com account.

     

    Press
    Enter
  • 50
    Powered by Jotform SignClear
    Press
    Enter
  • 51
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
    Cancelof
    Press
    Enter
  • 52

    We are pleased to cover travel and lodging expenses for speakers traveling more than 60 miles one way to the Symposium.

    Air Travel

    Air travel is covered at the economy rate, at must be booked least 3 weeks in advance.
    Baggage fees are covered, but seat upgrades are not included.


    Driving
    Mileage reimbursement is available at the current federal rate ($0.67/mile) for trips over 60 miles (one way), not to exceed the equivalent cost of an economy airfare. Mileage may be submitted at the closing of the conference via the Reimbursement Request Form.

    Lodging

    We are pleased to cover one night of lodging for each day you are presenting. However, if your travel requirements mean you need an extra night of lodging, please contact us so we can review and coordinate with you. If you’d like to extend your stay beyond what is covered, you’re welcome to do so — simply let the hotel know when booking, and you can cover the additional nights at your own expense.

    Meals and Expenses
    CCLC offers reimbursement for Meals & Incidental Expenses (ME&I) based on current U.S. General Services Administration (GSA) rates for Albuquerque, NM. No receipts are required for these rates.

    Please note: If your expenses exceed these rates or you wish to submit for reimbursement based on your home city and county rates, receipts will be required.

    Reimbursements and Honorariums

    A Reimbursement Request Form will be sent to all speakers at the close of the Symposium. Speakers are responsible for completing the form for all conference related expenses within 14 days of the closing of the conference.

    Reimbursements will be processed via bill.com within 45 days after the closing of the conference.  Constellation Consulting, LLC will invite you to open a free bill.com account and/or connect with your current bill.com account. This invitation will go out at the close of the conference along with a reimbursement form for each of you to complete.
    Speakers are responsible for creating and maintaining an up-to-date bill.com account.

    If you have any questions or need assistance with travel or accommodations, feel free to reach out. we're happy to help.

    Press
    Enter
  • 53
    I have read and understand the travel, lodging and reimbursement policies provided for speakers. I acknowledge that air travel must be booked at the economy rate at least 3 weeks in advance, that baggage fees are covered but seat upgrades are not, and that mileage reimbursement, lodging coverage, and meal/incidental reimbursements are subject to the stated policies. I agree to follow these guidelines, complete the Reimbursement Request Form within 14 days of the close of the conference, and maintain an active bill.com account in order to receive payment.
    Powered by Jotform SignClear
    Press
    Enter
  • 54
    Press
    Enter
  • 55
    Press
    Enter
  • 56
    Press
    Enter
  • 57
    attending sessions, networking events, meals
    Press
    Enter
  • 58
    (e.g., all three days, one full day, or specific times).
    Press
    Enter
  • 59
    Press
    Enter
  • 60
    (as it appears on your driver’s license or passport)
    Press
    Enter
  • 61
    -
    Pick a Date
    Press
    Enter
  • 62
    Press
    Enter
  • 63
    -
    Pick a Date
    Press
    Enter
  • 64
    Press
    Enter
  • 65
    -
    Pick a Date
    Press
    Enter
  • 66
    Press
    Enter
  • 67
    Press
    Enter
  • 68
    Press
    Enter
  • 69
    Precheck
    Press
    Enter
  • 70
    Press
    Enter
  • 71
    Press
    Enter
  • 72
    Press
    Enter
  • 73
    Press
    Enter
  • 74
    -
    Pick a Date
    Press
    Enter
  • 75
    -
    Pick a Date
    Press
    Enter
  • 76
    We’ll gladly take your preferences into account, though we can’t guarantee every request.
    Press
    Enter
  • 77
    Press
    Enter
  • 78
    Press
    Enter
  • 79
    • I affirm that I own or otherwise have the right to use the proposed content. I further affirm that I have the right to give consent to publish the content. By submitting this form, I grant Constellation Consulting, LLC and the State of New Mexico permission to share my presentation with clients, conference attendees and accrediting agencies.

    • I understand that I will be photographed during my presentation and that my name and likeness may be used for promotional purposes by Constellation Consulting, LLC and the State of New Mexico.

    • All payments and reimbursements will be processed via bill.com within 30 days after the closing of the conference. Constellation Consulting, LLC will invite you open a free bill.com account and/or connect with your current bill.com account. Speakers are responsible for creating and maintaining an up-to-date bill.com account.
    Press
    Enter
  • 80
    By signing, I confirm that I have read and agree to the terms outlined above.
    Powered by Jotform SignClear
    Press
    Enter
  • Should be Empty:
2026 NMSH Call for Presenters
[Edit]
Question Label
1 of 80See AllGo Back
close