*1.Name-List lead presenter first(Required.)

*2.Job Title(Required.)

*3.Organization/Site(Required.)

*4.Phone(Required.)

*5.Email(Required.)

6.Co presenter(s) information (Name, Title, Site, contact info)

*7.Title of Session(Required.)

*8.Please provide a brief description of your session (250 words or less) that includes the following information:

1) Theme

2) Objectives

3) Content

4) Mode of delivery (Lecture, hands on, panel discussion, outside, etc.)

5) Impact to participants (desired outcome for participants)

6) Maximum # of participants (if any)

7) A short summary statement to include in the itinerary documents if selected to present.(Required.)

*9.The length of this session will be(Required.)

45 minutes

90 minutes

*10.What will you need us to furnish for your session?  Check all that apply.(Required.)

Projector

Internet

TV

Laptop

Tables

Other (please specify)