Presenter Registration

 
 
1 Please enter your personal information:   2 Enter the workshop you are teaching:
  
Workshop #
First Name:
Last Name:
Company:
Address 1:
Address 2:
City:
State:
Zip:
Email:
Phone:
 

Enter a single class. If you are teaching more than one class,
we will ask you about it after you submit this form.

3 Enter the workshops you would like to attend:
  Do not request one half of a two-part intensive workshop
  Full Workshop List

   
1st Choice
2nd Choice
Thursday (101-121)  
Friday AM (201-230)  
Friday PM (301-330)  
Saturday AM (401-429)  
Saturday PM (501-529)  
Sunday (601-619)  

4 Please enter your menu choice below:
Additional Cost Items: There's no charge for your registration, however the following items are available at the cost indicated.

      quantity     quantity           cost
Thursday -
Box Lunch		   Turkey Breast   Vegetarian Sandwich           $27
Friday -
Luncheon		   Cobb Salad   Vegetable Cobb Salad           $38
Friday -
Dinner		   Filet Mignon   Vegetarian Puff Pastry       Sea Bass   $57
Saturday -
Luncheon		   Chicken Caesar Wrap   Vegetarian Pita            $38
Saturday -
Dinner		   Pecan Chicken   Grilled Portobello Mushroom     Tarragon Salmon    $57
Sunday -
Box Lunch		   Roast Beef Pita
   Vegetables in Pita           $27
  Credit Card:
Please enter your credit card information .

Card Number:
Expiration Date:
 
MM/YY
The cost will be totalled on your bill.

5 Audio Taping Permission:

Please note: Audio taping permission is automatic unless you submit this form byJanuary 15th.
Yes, you may tape my presentation.
My presentation includes confidential material AT THE END which I do not wish taped.
(The confidential material CAN ONLY APPEAR AT THE END; when we suspend taping, it can't be resumed.)
Please do not tape my presentation.

6 Audio Visual Equipment:
Slide Projector/Screen   Overhead Projector/Screen   VCR/Monitor
LCD Projector   DVD Player   LCD Screen ONLY
Cassette Tape Player   Flip Chart   CD Player
 
NO Computers will be provided. If you have your own LCD projector, please use it to save costs w/in AV budget.
 
Other:
 
Special Room Set Up:
 
  Rooms are set theater style. Flip charts are only provided when requested by you.
We'll provide microphones in the rooms that seat more than 40 people.

7 Handout Material:
Not Printed - Posted On-Line This Year

Yes, I will be sending a PDF formatted handout for my workshop. (Due February 6th)
No, I will not be sending handouts for my workshop