First Name: *

Last Name: *

Professional Title:

Organization:

Name(s) of Co-Presenters:

Email: *
[email protected]

Home/Cell Phone Number: *
xxx-xxx-xxxx

Work Phone Number: *
xxx-xxx-xxxx

Fax Number:
xxx-xxx-xxxx

Address: *

Address Line 2:

City: *

State: *
- Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip Code: *

Title of Presentation: *

Please keep title short and indicate pedagogical focus and science content.

Description: *

Please no more than 30 words.

Expected Session Size: *

Presentation Grade Level: *
Teachers prefer focused grade bands of 2-3 grades. You may select at most two presentation grade levels.
Kindergarten - 2^nd
3^rd - 5^th
6^th - 8^th
9^th - 12^th
College

Each room has a PC computer with the following:

• Internet access
• Data Projector
• Whiteboard
• Screen

Additional Equipment Needed:
Laptop
Document Camera
Table
Audio Hookup

* If you use a Macintosh computer you must bring your own adaptor.

Will you be attending the 12:00 PM luncheon? *
Please select Yes No

Co-Presenter from my Workshop Attending Lunch:
Please Select Yes No

Dietary Comments:

Sessions are 1 hour long. Please select 2nd and 3rd choices if applicable.

Session Preference 1: *
Please select 8:30 AM 9:45 AM 11:00 AM 12:45 PM 2:00 PM No Preference

Session Preference 2:
Please select 8:30 AM 9:45 AM 11:00 AM 12:45 PM 2:00 PM No Preference

Session Preference 3:
Please select 8:30 AM 9:45 AM 11:00 AM 12:45 PM 2:00 PM No Preference