Session Type
Please select...
Panel (1 moderator, 3 panelists)
Presentation
Workshop (lead a conversation or problem solving session)
Other (please specify):
Session Type:
I have other panelists in mind
I'd like your help putting together a panel.
About you:
First Name
Last Name
Organization or Affiliation
Position / Title
Email
Phone
Street Address
City
State
ZIP
Which Jurisdiction do you work in?
Washington, D.C.
Montgomery County, MD
Prince George’s County, MD
Fairfax County, VA
City of Alexandria, VA
Arlington, VA
Other (please specify):
Which jurisdiction?
Other Panelists
First Name
Last Name
Organization or Affiliation
Position / Title
Email
Phone
Street Address
City
State
ZIP
Phone
Your Proposal
Topic area:
How does your presentation or panel relate our theme,
Community Engagement and Safe Streets?
Proposed Title
Max 5 words
Session Abstract:
Max 150 words
Audience experience level:
What shared knowledge or experience does your session assume?
What will the audience learn?
Why is this topic important to this audience?
AV Requirements:
Display Slides
Play Video
Display Web Content
Other
Other AV:
Would you be open to presenting this workshop/panel in-person
?
Yes
No
Unsure
We are planning on presenting most panels/workshops via Zoom, is that alright with you?
Yes
No
Unsure
Contact Information