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NN22 Panel Submission Form
NN22 Panel Submission Form
Step
1
of
5
20%
I understand that a significant amount of work will be required of me in the weeks/months leading up to Netroots Nation.
*
I understand this and accept responsibility for this work.
I understand that while my idea may be selected, Netroots Nation may ask to alter the panel to fit general themes or ensure diversity.
*
I understand and accept that my panel proposal may be modified.
As a panel organizer, I will serve as an intermediary between Netroots Nation and my panelists/moderator. I will ensure that each speaker is informed of deadlines and updates and will communicate with the Netroots Nation team in a timely manner.
*
I understand and accept the role of panel organizer.
Because we have hundreds of speakers each year, we are unable to offer all speakers free registrations. However, we will work to ensure that cost is not a barrier for participation. Information on how to request a waiver will be sent to session organizers once sessions are selected.
*
I will ensure that my panelists are aware of this policy.
Name of panel organizer
*
First
Last
Email for panel organizer
*
Phone number for panel organizer
*
I understand that the timeliness of replying to organizers is important and am willing to accept text messages at the above number if needed.
*
I'm willing to accept text messages.
Organization/affiliation of panel organizer
*
Twitter handle of panel organizer
Just the handle; leave off the @. Example: "Netroots_Nation"
Role of the organizer (pick one)
*
Organizer only (not participating as a speaker)
Organizer will be the moderator
Organizer will be one of the panelists
Proposed name of panel
*
Will be displayed publicly.
Proposed description of panel
*
Must be 750 characters or less.
Will be displayed publicly.
Enter a one-paragraph description of the session you are proposing. This is how you would like to see it described in the convention program. You do not need to include the names of speakers in this section.
Why should Netroots Nation choose your session?
*
Must be 500 characters or less.
Will be displayed publicly.
What are the key takeaways for people who attend this panel? Why is this panel important to the progressive movement?
*
Must be 500 characters or less.
Will be displayed publicly.
The moderator of a panel is a very important role. The characteristics that make a good panelist may not be the same characteristics that make a good moderator. Please think carefully about who you would like to moderate this discussion to ensure that different viewpoints are brought in and that everyone on the panel, and the audience, will have a real chance to contribute.
Moderator name
*
Will be displayed publicly.
First
Last
Moderator email
*
Twitter handle for moderator
Just the handle; leave off the @. Example: "Netroots_Nation"
What kind of commitment have you secured from this person?
*
Available/planing to attend
Tentatively available
No contact but I am able to contact this person
No contact and I would likely need help to contact this person
Has this person moderated panels before?
Yes
No
Please describe the moderator's background and their experience moderating a lively and informative panel.
*
Must be 500 characters or less.
We strive to make Netroots Nation fully inclusive and representative of the progressive movement. Your responses to the following questions help us track our outreach efforts and ensure that our event is intersectional and diverse. Responses are confidential.
Gender of the moderator
Female
Male
Non-binary/third gender
Gender non-conforming
Gender fluid
Unknown/Choose not to answer
Does this person self-identify as a person with a disability or chronic health condition?
Yes
No
Unknown/Choose not to answer
Does this person self-identify as LGBTQ?
Yes
No
Unknown/Choose not to answer
Ethnicity of the moderator
Black or African-American
Hispanic or Latinx
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiracial/Multi-ethnic
Unknown / Choose not to answer
Maximum of 4 panelists (NOT including the moderator). Please adhere to this limit.
Panelist 1
Panelist name
*
Will be displayed publicly.
First
Last
Panelist email
*
Twitter handle of panelist
Just the handle; leave off the @. Example: "Netroots_Nation"
What is this panelist's unique role for this panel?
Must be 500 characters or less.
What expertise does this person bring? What is their viewpoint? What will they bring to the discussion?
Please do not simply cut and paste a bio. We want to know what perspective they bring to the discussion, not just biographical information.
What kind of commitment have you secured from this person?
Available/planning to attend
Tentatively available
No contact but I am able to contact this person
No contact and I would likely need help to contact this person
Gender of the panelist
Female
Male
Non-binary/third gender
Gender non-conforming
Gender fluid
Unknown/Choose not to answer
Does this person self-identify as a person with a disability or chronic health condition?
Yes
No
Unknown/Choose not to answer
Does this person self-identify as LGBTQ?
Yes
No
Unknown/Choose not to answer
Ethnicity of the panelist
Black or African-American
Hispanic or Latinx
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiracial/Multi-ethnic
Unknown / Choose not to answer
Panelist 2
Panelist name
Will be displayed publicly.
First
Last
Panelist email
Twitter handle of panelist
Just the handle; leave off the @. Example: "Netroots_Nation"
What is this panelist's unique role for this panel?
Must be 500 characters or less.
What expertise does this person bring? What is their viewpoint? What will they bring to the discussion?
Please do not simply cut and paste a bio. We want to know what perspective they bring to the discussion, not just biographical information.
What kind of commitment have you secured from this person?
Available/planning to attend
Tentatively available
No contact but I am able to contact this person
No contact and I would likely need help to contact this person
Gender of the panelist
Female
Male
Non-binary/third gender
Gender non-conforming
Gender fluid
Unknown/Choose not to answer
Does this person self-identify as a person with a disability or chronic health condition?
Yes
No
Unknown/Choose not to answer
Does this person self-identify as LGBTQ?
Yes
No
Unknown/Choose not to answer
Ethnicity of the panelist
Black or African-American
Hispanic or Latinx
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiracial/Multi-ethnic
Unknown / Choose not to answer
Panelist 3
Panelist name
Will be displayed publicly.
First
Last
Panelist email
Twitter handle of panelist
Just the handle; leave off the @. Example: "Netroots_Nation"
What is this panelist's unique role for this panel?
Must be 500 characters or less.
What expertise does this person bring? What is their viewpoint? What will they bring to the discussion?
Please do not simply cut and paste a bio. We want to know what perspective they bring to the discussion, not just biographical information.
What kind of commitment have you secured from this person?
Available/planning to attend
Tentatively available
No contact but I am able to contact this person
No contact and I would likely need help to contact this person
Gender of the panelist
Female
Male
Non-binary/third gender
Gender non-conforming
Gender fluid
Unknown/Choose not to answer
Does this person self-identify as a person with a disability or chronic health condition?
Yes
No
Unknown/Choose not to answer
Does this person self-identify as LGBTQ?
Yes
No
Unknown/Choose not to answer
Ethnicity of the panelist
Black or African-American
Hispanic or Latinx
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiracial/Multi-ethnic
Unknown / Choose not to answer
Panelist 4
Panelist name
Will be displayed publicly.
First
Last
Panelist email
Twitter handle of panelist
Just the handle; leave off the @. Example: "Netroots_Nation"
What is this panelist's unique role for this panel?
Must be 500 characters or less.
What expertise does this person bring? What is their viewpoint? What will they bring to the discussion?
Please do not simply cut and paste a bio. We want to know what perspective they bring to the discussion, not just biographical information.
What kind of commitment have you secured from this person?
Available/planning to attend
Tentatively available
No contact but I am able to contact this person
No contact and I would likely need help to contact this person
Gender of the panelist
Female
Male
Non-binary/third gender
Gender non-conforming
Gender fluid
Unknown/Choose not to answer
Does this person self-identify as a person with a disability or chronic health condition?
Yes
No
Unknown/Choose not to answer
Does this person self-identify as LGBTQ?
Yes
No
Unknown/Choose not to answer
Ethnicity of the panelist
Black or African-American
Hispanic or Latinx
Asian
American Indian or Alaska Native
Middle Eastern or North African
Native Hawaiian or other Pacific Islander
White
Multiracial/Multi-ethnic
Unknown / Choose not to answer