Workshop Information

Workshop Title


Workshop Abstract (50-word maximum)
If the workshop is accepted, the abstract will be included in the program.)

Workshop Description (250-word maximum)
Provide a description of what attendees will learn and what activities (if any) you will use during your presentation.

Please provide three objectives for your presentation: an objective should state the information, understanding, or skills participants will gain as a result of their attendance in this workshop. If three objectives are not supplied, your presentation will not be selected.

Please DO NOT COPY/CUT & PASTE into this field,
as doing so may generate errors upon submission.

Room Setup
Please check all appropriate boxes.

	Classroom			Panel (Set for )			Roundtable
	Technology Lab			Internet Hookup (additional cost to presenter)
	Additional Tables (#: )

Primary Track Selection
Please indicate primary area.

		Innovative Instructional Practices
		Numeracy
		English as a Second Language / Citizenship
		Student Involvement & Leadership
		Transitions
		Program Improvement / Accountability & Innovative Program Practices
		Fund Development, Advocacy & Marketing
		Technology

Target Audience
Please indicate target audience(s).

		Administrators			Board Members
		General Audience			Instructional Staff
		Program Coordinators			Program Directors
		Students/Learners			Trainers
		Volunteers/Tutors

Additional Presentation Aids
If your workshop is selected and you need to utilize AV equipment other than an overhead transparency projector and flipchart, we will provide your information to the hotel. You will then contract individually with the hotel.

Additional AV � please fill out the additional AV request form (click here to download). Please note the hotel will supply additional AV at the hotel rate.

Lead Presenter
This individual is responsible for relaying information between the conference team and the co-presenter. Please provide your primary contact information.

First Name

Last Name

Title

Organization

Address Line 1

Address Line 2

City

State

Postal Code

Telephone

Fax

E-mail

Biographical Information (40-word maximum)

Co-Presenter

First Name

Last Name

Title

Organization

Address Line 1

Address Line 2

City

State

Postal Code

Telephone

Fax

E-mail

Biographical Information (40-word maximum)

Presenter Agreement
By submitting this application, you agree to the following:

I understand that the lead presenter and one co-presenter:

• Must register and pay the reduced conference rate (any additional presenters must pay the full conference rate)
• Will be responsible for all costs related to transportation, room, and board
• Will be responsible for furnishing handouts in the quantity needed
• Will be responsible for costs of audio-visual equipment requested other than an overhead transparency projector and one flip chart