Expanding Your Horizons Presenter Registration Form

EXPANDING YOUR HORIZONS IN SCIENCE AND MATHEMATICS
WORKSHOP PRESENTER REGISTRATION FORM

Texas Wesleyan University, Fort Worth, TX
Saturday, March 29, 2012

Please register BEFORE January 14, 2012.

Name:

Job Title or Department:

Employer:

Mailing Address:

City:

State:

Zip:

Office Phone:

Extension:

Cell Phone:

Fax:

Email Address:

Workshop title (short, catchy title that will generate interest in your field):

Short description of hands-on workshop:

We ask that each presenter give two 45 minute workshops. Please mark your workshop time preference. We will make every effort to honor your request. Confirmation letters will be sent out approximately one month before the conference. Workshops will start at 10:30AM this year and the afternoon workshops will end at 2:30PM.

Workshop Time Preference:

Two morning workshops (approx. 10:15AM – 12:10PM)
Two afternoon workshops (approx. 12:30PM – 2:30PM)
Four workshops (morning and afternoon presentations)
No preference (available for either morning or afternoon)

Please describe needs for special equipment or room arrangements (audiovisual, laboratory space, sinks, large tables, electrical outlets, etc.):

General Topic:

Thank you for your participation!

Presenter Registration Form

EXPANDING YOUR HORIZONS IN SCIENCE AND MATHEMATICS WORKSHOP PRESENTER REGISTRATION FORM

EXPANDING YOUR HORIZONS IN SCIENCE AND MATHEMATICS
WORKSHOP PRESENTER REGISTRATION FORM