Personal Information

Check one:    Mr.     Mrs.  Ms.   Dr.   Sr.

First Name: Middle Name: Last Name:

Preferred Contact Information

Email Address:

Street Address:

City:       St.        Zip

Phone:

School  or Business Information

School or Business:       

Position/Title:

School/Business Street Address: 

City:       St.       Zip:

Workshop Information

Type of Workshop:  Choose One Presentation Hands_on

Level of Workshop:  Choose One K - 5 6 - 12 Any Level

If hands-on, what level of ability should your audience have?   Choose One Beginner Intermediate Advanced Any Level

Title of Workshop:

Brief Description for Program (approximately 50 words). Please check spelling and grammar before submitting your description. Sample session descriptions.

Hardware/Software and Equipment needed:

Projector for PC   Projector for Mac  

For Hands-on Presentations only: Software Loaded

WiFi is available if you need an Internet connection.

Information Strand Addressed

Co-presenter

Is anyone else presenting with you? YES     NO
(Co-presenters are limited to one. )  If yes, please:

Check one:    Mr.     Mrs.  Ms.   Dr.   Sr.

First Name:    Middle Name: Last Name:

Email Address:

Position/Title:

Street Address:

City:       St.        Zip

Phone:

School/School District/Organization:

Additional Comments: