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Appendix D
Instructions: Please fill out this form as completely as possible. Selection will be primarily based on the information you provide here. If you have any questions, call (name and phone number of contact person).
In this space, the contact person should provide information about:
* Conference theme.
* Dates of the conference.
* Objectives and/or purpose.
* Anticipated number of participants.
* Topics being sought.
* Final date for submission.
* Special instructions on typing or printing proposal, number of copies, exact address for submission, and attachments.
1. Proposed title of session: ___________________________________________
2. Type of session: General ________ Concurrent________ Breakout________
3. Presenter(s):
(If more than one, list as A and B. The person listed as A will be considered the primary correspondent.)
A. Name:____________________________________________________
Address:__________________________________________________
__________________________________________________
Telephone: Work ( )_____________ Home ( )_______________
Organization:______________________________________________
Division:__________________________________________________
B. Name:____________________________________________________
Address:__________________________________________________
__________________________________________________
Telephone: Work ( )_____________ Home ( )__________________
Organization:______________________________________________
Division:__________________________________________________
4. Brief description of the proposed session in 50 words or less. (If you are selected, you will be asked to revise this description for preconference publicity and for the participant book.)
5. Indicate the type of participant to whom your session will be directed (check one).
A. No experience or knowledge. _______
B. Some experience or knowledge. _______
C. Substantial experience or knowledge. ______
6. How would participants benefit from attending your session?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
7. Briefly describe the techniques/methods you would use to conduct this session.
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
8. What special room setup and audiovisual requirements would you have?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
9. Have you previously conducted this or a similar presentation?
Yes _______ No ________
A. If so, please provide the following information on the organization to which you presented this session:
1. Contact name/title_________________________________________
2. Organization_______________________________________________
3. Phone______________________________________________________
B. If not, why do you want to offer this session?
_______________________________________________________________
_______________________________________________________________
10. Preferred scheduling:
The conference will be held on the date(s) indicated on page one of this form.
What date do you prefer? ________________________
(if your meeting will last longer than one day)
Morning session_________________ Afternoon session__________________
11. Financial arrangements:
(This section will vary with each sponsor. In some cases, the policy statement of the sponsor can be provided. In others, the following may be used.)
Are you requesting any of the following?
A. Honorarium/fee $_____________
B. Travel reimbursement $_____________
C. Accommodations $_____________
D. Other (please specify) $_____________
12. Taping and publications:
A. If you are selected, will you grant permission for taping (audio or video) of your session?
Yes ________ No ________
B. If you have a prepared paper, will we have permission to publish it as part of the conference proceedings?
Yes ________ No ________
13. Any special comments or questions? __________________________________
_____________________________________________________________
SOURCE: The Comprehensive Guide to Successful Conferences and Meetings by Leonard Nadler and Zeace Nadler. San Francisco: Jossey-Bass. Copyright 1987. Permission to reproduce hereby granted.
The information on this page is archived and provided for reference purposes only.