POW Sponsor/Speaker Proposal

We’ll review every proposal we receive. If we’re able to accommodate your topic at this year’s conference, we’ll contact you within 72 hours. If we’re not able to fit it into POW, we’d still love to collaborate—your proposal will be kept on file for future conferences and projects, and we may reach out at a later date.

Organization/Company

Headquarters (City/State)

Website URL

Primary Presenter Name(s):

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Title/Role

(Required if CE requested)

Briefly describe what your product/service solves for mental-health practices or how your speaking topic relates to mental-health practices.(120–160 words)

How did you hear about POW?

Sponsorship Tier

Track (1st Choice)

*Track Sponsor spots are limited (one per track; 4 total)

Track (2nd Choice)

*Track Sponsor spots are limited (one per track; 4 total)

Request NBCC CE review for this session?

(Note: Not all accepted sessions will be CE-eligible.)

Format

Instructional level

Preferred Billing Method

Billing Name: First Name Last Name Billing Address:blank Street Address Address Line 2 City State Zip Billing Phone#: Area Code Phone Number Billing E-Mail: Email

My Products

(HERO)Track Sponsor

• Exclusive branding across one track (Administrative Professional, Practice Manager/COO, Practice Owner/CEO, Solo Practice) • Premium Expo Floor placement • 30-Minute live Product Demo + Q&A (Thursday) • Dedicated social media plugs pre-event • Inclusion in follow-up marketing emails to participants after the event • Dedicated product chat room (with video feed) open for the entirety of the event • Post event analytics including lead generation

$3,500.00 Quantity

(CHAMPION) Product Demonstration

• 30-minute live Product Demo (Thursday or Friday, based on availability) • Virtual Expo booth + featured social media post • Post event analytics including lead generation • Dedicated product chat room open in designated two hour block

$2,000.00 Quantity

(ALLY) Visibility Package

Pre-recorded video placement+coupon code/free trial

$299.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Three measurable learning objectives (bullet points)

Primary NBCC content area(s)

60-minute timed outline (5–6 lines)

Evidence base (2 key references, APA or links)

Qualification summary for this topic (degree + years + role)

This is a brief intro; we will obtain required CE documentation once presentations are selected

As a potential CE Speaker, my presentation...

Financial relationships to disclose?

Describe briefly:

Signature

Title

Date

I understand that as a Sponsor/Speaker I will be subject to guidelines and deadlines set forth by Semi-Private Practice. These conditions will be sent to my email provided upon acceptance/completion of this form.

POW Speaker/ Sponsorship Request

Presenter & Contact

Sponsorship & Presentation

PAYMENT

My Products

CE Quick Screen

Disclosures & Compliance

CE NOTE: