Please enter your information below.
If you are speaking or moderating in more than one workshop, you must submit this form for each session.
Please reach out to your Alliance workshop organizer(s) with any questions.
Dr. Mr. Mrs. Ms. Mx. Rev.
Speaker Pronouns *
Please indicate speaker's pronouns. Multiple pronouns may be indicated in the "Other" box.
Please select: * Who is the Alliance staff member organizing your workshop? Please Select Alex Visotzky Allie Pivik Andrew Hall Ann Oliva Caitlin Mello Chandra Crawford Jerry Jones John Threkeld Josh Johnson Joy Moses Kay Moshier McDivitt Rachel Pearsall Samantha Wood Sharon McDonald Steve Berg Yolanda Stevens N/A - Presentation selected via Call for Presentations Short Biography *
1000 character limit.
Dietary Restrictions * Other Dietary Restrictions Pursuant to the Americans with Disabilities Act do you require specific aids or services? Audio Visual Mobile Optional Demographic Questions
We are collecting demographic information in order to support our efforts in increasing diversity at our conferences.
Do you consider yourself Hispanic, Latinx, or Spanish origin? Which of the following five racial designations best describes you? More than one choice is acceptable. Which of the following most closely represents your gender identity? Are you currently experiencing or have you in the past experienced homelessness? Speaker Agreement
This Agreement is made between SPEAKER NAME hereinafter referred to as "Speaker" and National Alliance to End Homelessness, located at 1518 K Street, NW, Second Floor, Washington, DC 20005, hereinafter referred to as "Alliance". The effective date of this Agreement is the date of submission of this form (06/06/2023).
Engagement: Speaker, shall participate in the SESSION NAME
Risk: Speaker shall present the sessions contemplated by this Agreement. Speaker shall indemnify and hold harmless Alliance from any claim, demand, loss, liability, damage or expense arising in any way from the Facilitator’s performance of services.
License for Content archiving/capture/distribution: Speaker grants to Alliance an exclusive license to use Speaker’s presentation and handout materials (collectively “Speaker Property”) in any manner Alliance deems appropriate including, but not limited to, the resale in a Alliance controlled content library, reproduction, distribution, creation of derivative works, and display on the internet of Speaker Property, with Alliance retaining the proceeds derived from such distribution and use of Speaker Property.
Speaker also agrees to work directly with the AV company performing these services for Alliance and follow all deadlines to provide PowerPoint presentations, handouts, and recordings that may be associated for content archiving.
By selecting "I agree" below, I agree to comply with all criteria outlined in this agreement. I further acknowledge and consent to Alliance’s use and distribution of my spoken word including newsletter articles, posting of information to the Alliance web site and any supporting materials I have provided. I release Alliance, its officers, employees and agents from any liability that may arise from such use and distribution. Please select: * COVID 19 Vaccination Policy COVID 19 Vaccination Policy * Please review the full vaccination policy here.
Any required documentation will need to be uploaded to Crowdpass, the Alliance’s platform for COVID-19 clearance. Alliance staff will reach out with instructions on accessing Crowdpass after registration is complete.
As a condition of attendance at the Innovations and Solutions for Ending Unsheltered Homelessness conference (March 1-3, 2023), individuals must be up to date with all vaccinations against COVID-19 by the first date of the conference. For purposes of this policy,
an individual is considered up to date
with their COVID-19 vaccination
if they have received all recommended doses in the primary series and one booster
Getting a second booster is not currently required.
Individuals who are requesting a medical or religious exemption from the COVID-19 vaccination must submit:
Proper documentation as detailed below, and
Proof of negative COVID-19 PCR or antigen test results. Date of the test must be no earlier than Monday, February 27th, 2023, or within two days (48 hours) of the start of the Event. Individuals will be responsible for the cost of such testing. The test results must include the individual’s name and date of test from a reputable clinic or professional medical office. Rapid at-home tests are not acceptable for entry. Document Requirements for Exemption Approval
Approved Medical Circumstance:
History of previous allergic reaction to indicate an immediate hypersensitivity reaction to a component of the vaccine; health condition or medical circumstances such that immunization is not considered safe; or any other health condition or medical circumstance where receiving the COVID-19 vaccine is contraindicated.
A letter from your medical provider explaining the medical reasoning prohibiting your receipt of the COVID-19 immunization Document for Exemption: Approved Sincerely-Held Religious Belief:
Religious belief and/or practice which is (a) sincerely held; and (b) which prohibits receiving immunizations.
A letter from your religious leader (priest, preacher, rabbi, imam, etc.) explaining the religious teachings prohibiting receipt of the COVID-19 immunization Document Requirement:
I have read and agree to this policy. IMPORTANT: If you are submitting this on behalf of another individual, you are agreeing to this policy on their behalf. Please ensure they can abide by this policy before registering them. Any required documentation will need to be uploaded to Crowdpass, the Alliance’s platform for COVID-19 clearance. Alliance staff will reach out with instructions on accessing Crowdpass after registration is complete. Code of Conduct *
The National Alliance to End Homelessness strives to create a diverse, inclusive, accepting, and safe space for everyone.
The Alliance works to ensure that diverse voices are included as speakers, attendees, and guests at our conferences and webinars. All voices are welcome.
The organization has a zero-tolerance policy for any form of discrimination or abusive behavior. The Alliance is committed to ensuring that all its events are safe and respectful for all participants.
During the registration process, participants will be asked to check a box agreeing to treat fellow participants respectfully, helping to ensure welcome conversation from all participants. By checking this box, participants also acknowledge that any form of discrimination, violence, or abusive behavior may result in removal from a session, webinar, or conference, depending on the situation.
If any discrimination is witnessed or experienced during this conference or webinar, or if you feel unsafe, please notify any member of the Alliance staff. I agree to abide by this code of conduct. IMPORTANT: If you are submitting this on behalf of another individual, you are agreeing to this code of conduct on their behalf.