Workshop Presenter Application Form

Presenter(s) Name(s)
Program or Affiliation
Address
City, State, Zip
Email
Phone Work Phone Home

Which of the above information may we publish in the conference program so participants may contact you?
All None Partial: Address Phone Email Other:

Workshop Title
Topic
Brief Description (limit 30 words)
Brief bio (limit 30 words)

Are you willing to present more than one session if your workshop fills up? Yes No
If yes, do you want them back to back or with a break? back to back break

Amount of time needed for workshop:
single session ~1.25 hours
double session ~2.75 hours
all day session ~5.5 hours

Schedule preferences (give three choices, in order of preference - times are approximate)
Saturday morning: 9 to 10:15, 10:30 to 11:45; Saturday afternoon 2:30 to 3:45, 4:00 to 5:15; Sunday 10:30 to 11:45

Where will your workshop work best? Indoors Outdoors Either

Do you need to limit the number of participants: No Yes number

Target audience
  experience: new environmental educators   experienced environmental educators   all
  profession: residential outdoor school   classroom teacher   day program, nature centers or museum   all

Will you have handouts or other materials for your participants? Yes   No

Do you need to charge a materials fee?  No  Yes  $amount

Do you have an special needs for your workshop? For example, do you need chairs? Tables? Open space? A large playing field? A room that can be dark for slides? do you need electricity? Running water? A VCR, overhead projector, slide carousel/screen, other materals?

Will you be registering for the conference? Yes   No
Do you want to be sent a registration packet (all members receive them automatically)? Yes  No