| 1. Please write all biographical information as you wish it to appear on conference publicity. |
| Name: | Title: |
| Current Employer: |
| Mailing Address: |
| City: | State: | Zip: |
| Phone: | Fax: | Email: |
| Social Security Number (for CEUs-not to be published) |
| Title of Presentation: |
| 2. On a separate sheet of paper, please give a brief description of the session in 50 words or less. (If you are selected, you will be asked to revise this description for conference publicity.) |
3. Indicate the type of participant to whom your session will be directed:
- No experience or knowledge of the topic.
- Some experience or knowledge of the topic.
- Extensive experience or knowledge of the topic.
|
| 4. Briefly describe the techniques/methods you will use to conduct this session. |
| 5. What special requirements will you have for room setup and audiovisual materials? |
6. Have you previously conducted this or a similar presetation? (circle one)
yes no
If yes, please provide the following for reference:
|
| a. Name | Organization: | Phone: |
| b. Name | Organization: | Phone: |
| 7. Will there be a limit to the number of participants? (circle one) |
| yes no (indicate limit) _______ |
| 8. When do you prefer for your presentation? | |
| Nov. 7, 2001 | Nov 8, 2001 |
| a.m. | a.m. |
| p.m. | p.m. |
