Product Demo Presentation Proposal

Conference Date and Location: October 24 & 25, 2019
Hartford/Windsor Marriott Airport Hotel, Windsor, CT


If your proposal is selected, Sponsors/Exhibitors will have an opportunity to present information in a scholarly manner along with product demos during a 90-minute session. Only 4 time slots are available! Please complete the following form in order to be considered to present a Product Demo Learning Lab at the 2019 Conference on Mainstreaming Children with Hearing Loss. The Conference Committee will review your submission and notify you of your status via email during the week of March 18, 2019.

Please scroll down to complete the online form.

To complete offline, download this PDF form fill it out, and send it to

Deadline for Submission: February 25, 2019

Required Presentation Information

Presentation Format will be a 90-minute Mini-Workshop and will be offered either in the morning (10:30 am - 12 pm) OR in the afternoon (1:15 pm - 2:45 pm).

Primary Presenter

(If additional presenters, please submit the following information for each.)

Presentation Abstract: (250 words maximum)

Workshop Outline (Include key issues to be addressed)

ASHA Required Disclosures for All Presenters/Speakers

In compliance with American Speech-Language Hearing Association’s (ASHA) Continuing Education Board’s Requirements, Clarke Schools for Hearing and Speech requires that all presenters/speakers to disclose information regarding any financial and non-financial relationships related to course content prior to and during course presentations.

Disclosure Statements are REQUIRED on Your Opening PowerPoint Slides
Disclose any and all, real or potential conflicts of interest. Name any and all professional, financial or personal affiliation which may cause the impression that bias or prejudice could affect the objectivity of materials presented.

Relevant financial relationships are those in which the individual benefits by receiving a salary, royalty, intellectual property rights, gift, speaking fee, consulting fee, honoraria, ownership interest or other financial benefit. Financial relationships can also include “contracted research” where an institution gets the grant and manages the funds and the individual is the principal or named investigator on the grant.

Examples of relevant financial relationships may include:

  • Being an employee of, or a paid consultant to, an organization whose product or service you discuss in your presentation
  • Receiving grant funds for a research project you discuss in your presentation
  • Receiving royalties from the sale of a book whose content you discuss in your presentation

Relevant non-financial relationships are those that might bias an individual including any personal, professional, political, institutional, religious or other relationship. This may also include personal interest or cultural bias.

Examples of relevant non-financial relationships may include:

  • Serving as a formal advisor to a review panel
  • Sitting on the board of an organization whose product or service you discuss in your presentation
  • Receiving an award or honor from an organization whose product or service you discuss in your presentation

My Relevant Financial relationship disclosures are:

My Relevant Non-financial relationship disclosures are:

Learning Lab Product Demonstration Agreement:

By submitting this proposal, I understand: