2013 Summit Presenter Form

Thank you so much for volunteering to present at the 2013 Summit! We look forward to your presentation and want to assist you in putting on a smooth event – let us know what you need. Any questions? Call Cathy McGuire at 541-367-0711.

 

All *fields are required

Your Name*:

Title:

Agency*:

Address Line 1*:

Address Line 2:

City*:

Zip code*:

Phone*:

Your Email*:

Presenter Name*(1):

Presenter Name(2):

Presenter Name(3):

Lunch is provided. Number of lunches needed*:

Session Title*:

Number of presentations (1, 2 or 3)*: 123

Check all that apply:
Sessions you can present*: Session 1, 9:25-10:15aSession 2, 10:25 – 11:15aSession 3, 12:05-12:50p

Check all that apply*:
Grades: 4-56-89-12

Session Description*: (One lively, interesting and irrestible paragraph, please)

Please list your specific needs regarding the following:

Volunteers* (how many, and to do what tasks?):

Do you need an electrical connection*? yesno
(If yes, please be prepared to bring your own electronic equipment and extension cords.)

Room Setup* (tables and chairs configuration)
AuditoriumClassroom with tables and chairsMessy hands-on type activity

Water source needed? yesno

Other special needs? yesno

If yes, please specify:

Can you provide a small door prize for each session? yesno

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