Presenter Registration Form


Expanding Your Horizons in Science and Mathematics
Workshop Presenter Registration Form

Saturday, March 29, 2014
Texas Wesleyan University, Fort Worth, TX

Please register before Jan. 15, 2014.

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:
 
 

Each presenter receives an Expanding Your Horizons T-shirt. Please select your size.

T-shirt Size:
S M L XL XXL XXXL
 

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!

   
 
Contact Information


Dr. Jane Moore

EYH Conference Director
Professor of Mathematics
Phone: 817-531-4882
Fax: 817-531-4202
jamoore@txwes.edu

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