Contact Presenter
Last Name_____________________________________ First Name______________________________________
Institution ______________________________________________________________________________________
Office Address _________________________________________________________________________________
City_________________________________________________ State________________ Zip__________________
Phone __________________________________ FAX___________________________________
Email___________________________________________________________________________________________
List Additional Presenters _________________________________________________________________________
Title of Session ____________________________________________________________________________________
Session Format Workshop Demonstration Round Table Panel Discussion Presentation
Length of Session 1 hour 2 hours Maximum Size of Audience _______________
Intended Audience
New Professionals Seasoned Professionals Administrators Instructors Support Personnel
Peer Tutors SES Providers Small Business Owners Other
Topic Category:
Please describe up to 3 categories where you feel your topic best fits for audience relevancy and usefulness.
Examples: Peer Tutoring, Program Management, Ethics and Standards, Learning Theory, Mentoring, Collaborative Learning, Diversity, etc.
______________________________________________
______________________________________________
______________________________________________
Audio-Visual Needs
Overhead Projector (Free upon request) Screen only (Free upon request) Flip Chart ($10)
LCD Projector ($125) LCD Support Package – You bring the LCD projector but need screen, power surge protector etc. ($75) DVD or VCR Player and Monitor ($225) Internet Connection (Hotel to determine rate)
PLEASE NOTE THAT LAPTOP COMPUTERS ARE NOT AVAILABLE FOR RENTAL . ALL AV COSTS MUST BE PAID WITH CONFERENCE REGISTRATION. WE CANNOT ACCEPT AV CHANGES OR NEW REQUESTS WITHIN 5 DAYS OF THE CONFERENCE. ALL AV PRICES ARE SUBJECT TO 21% SERVICE CHARGE AND APPLICABLE STATE TAXES AS CHARGED BY THE CONFERENCE HOTEL.
Summary:
Please type your summary on a separate page (250 word max.) If your proposal is accepted, your summary will appear in the conference program.
I understand that all presenters and co-presenters will . . .
1. Register for the conference and pay registration fee as well as any additional AV costs as per my request.
2. Be responsible for all costs related to transportation, room, and board.
3. Be responsible for providing handouts for a minimum of 75 participants.
4. Not be paid an honorarium.
5. Submit any address, name or presentation information change.
Presenter Signature_______________________________________________ Date ______________________
Submit completed proposals to: NTA Conference Proposal
PO Box 6840 Lakeland FL 33807-6840
