Conference Presenter Application Form

Please return completed forms to Tamara Palmer, 110-A Fairbanks St, Santa Cruz CA 95060. Deadline April 13, 2001.

Name:__________________________________________________________________________________

Organization (if applicable):________________________________________________________________

Mailing Address:_________________________________________________________________________

Phone (H/W): _____________________________e-mail:_________________________________________

Which of the above information may we publish in the conference program so participants may contact you? (Circle your choices below)

ALL Address Phone e-mail NONE Other (list below)

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Workshop Title:________________________________ Topic:____________________________________

Brief description of: 1) your workshop, and 2) yourself (presenter background), for the registration packet:

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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 between?____________________________________

Amount of time needed for your workshop (single sessions are 1 hr., 15 min; double sessions, 2.75 hrs):

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Schedule preferences (give three choices, in order of preference -- times are approximate):

Saturday morning: 9-10:15, 10:30-11:45; Saturday Afternoon: 2:30-3:45, 4-5:15; Sunday: 10:30-11:45 am

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Where will your workshop work best? (circle one): INDOORS OUTDOORS EITHER

Do you need to limit the number of participants? NO YES Number________

Will you have hand-outs or other materials for your participants? NO YES

Do you need to charge a materials fee? NO YES Amount: $___________

Do you have any special needs for your workshop? For example, do you need chairs? Tables? Open space?

A large playing field? A room that can be made dark for slides? Do you need electricity? Running water?

A VCR, Overhead Projector, Slide Carousel/Screen, other materials?

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Will you be attending the conference? YES NO (Register separately, discount for presenters)