1.  Title of Presentation:

workshop length:3 hours or 6 hours
 

Title:          Mr. Mrs. Ms. Dr. Rev.

First Name:       

Last Name:       

Street Address: 

City:                    

State:                  

Province:           

Zip Code:          

Work Phone :    

Home Phone:    

Your Email Address:

2.  Please provide brief description of proposed session (150-200 words)
 

3.  Indicate the type of participant to whom your session will be directed:

No experience or knowledge Some experience or knowledge Significant experience or knowledge

4.  Briefly describe the techniques and methods you would use to conduct this session:

5.  How would participants benefit from attending this session?

6.  Will there be a testing component of your session?  How would you measure knowledge gained?

7.  Have you previously conducted this session?

Yes No

7a.  If yes, where:

8.  Please provide one professional reference:

Name:           

Organization: 

Phone:          

Email:           

Once you submit your proposal here, you will see a summary of your information.  Please print this page for your records.

Thank you for your submission.