Session Information

• Proposed Title:
• Format: (choose one)
  Presentation DemonstrationRoundtable
• Target Audience: (Check all that apply)
  Adult Ed.  After School Programs  Community Ed. 

  
  

  Continuing Ed.

  Corrections Ed.  ESL 
• Session Title:
• Session Abstract for Conference Program: (75 words or less)
• Session Preference: (indicate 1, 2, or 3 for 1st, 2nd, or 3rd choice or indicate no preference)
  10:00 - 11:00 am
  11:10 am - 12:10 pm
  1:30 - 2:30 pm
  3:00 - 4:00 pm
  No Preference
• Audio/Visual Equipment Needs: (A computer projector will be provided in each room. However, no laptops will be provided.)
  Overhead Projector  TV/VCR (VHS)  Flip Chart  Computer Sound 
  Other (specify): 

Lead Presenter

• Name:
  
• Title:
• Organization:
• Address:

• City:		State:
  Zip:
  Day Phone:		Home Phone:
  Cell Phone:		Fax:

• E-mail Address:
• Brief Bio: (150 words or less.)

Contact Person:

• Name:
  
• Title:
• Organization:
• Address:

• City:		State:
  Zip:
  Day Phone:		Home Phone:
  Cell Phone:		Fax:

• E-mail Address:
• Confirm E-mail Address:

Co Presenter 1:

• Name:
  
• Title:
• Organization:
• Address:

• City:		State:
  Zip:
  Day Phone:		Home Phone:
  Cell Phone:		Fax:

• E-mail Address:
• Short Bio: (to appear in program)

Co Presenter 2:

• Name:
  
• Title:
• Organization:
• Address:

• City:		State:
  Zip:
  Day Phone:		Home Phone:
  Cell Phone:		Fax:

• E-mail Address:
• Short Bio: (to appear in program)

Additional Information

• Presnter(s) is/are member(s) of UAACCE:
  
  Yes No
• Presenter(s) is/are registering for conference: (Registration is a separate process from this call for proposal.)
  
  Yes No
• If not registering for conference, would presenter like to purchase a lunch ticket(s)?
  Yes No
• How many tickets are needed?:

Verification Code:

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