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Lead Presenter Last Name:
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Lead Presenter First Name:
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Program/Organization/Company
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Professional Title/Position
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Email Address:
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Mailing Address
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City
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State
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Zip Code
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Telephone
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Mobile Phone (For emergency and on-site use)
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Presenter Biography* Note information may be printed in Conference Brochure
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Indicate Highest Degree Completed
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H.S. Diploma
B.A. Degree
Master's Degree
Doctorate
Other Credential
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1st Co-Presenter-Last Name
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1st Co-Presenter-First Name
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1st Co-Presenter -Program/Organization/Company Name
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2nd Co-Presenter Last Name
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2nd Co-Presenter First Name
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2nd Co-Presenter-Program/Organization/Company Name
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Title of Presentation:
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Provide up to three sentences concisely describing the session (3rd person descriptions preferred) R7HSA reserves the right to edit descriptions for the purpose of publishing and marketing event materials
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Learning Outcomes/Objectives: Please indicate 2-3 measureable learning outcomes that participates will gain from attendace at the workshop
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Presentation Material: R7HSA events are considered "Green". Presenters are encouraged to submit presentation material at the time of proposal submission or before February 1st.
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Please indicate the target audience for this workshop
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New Staff (individuals who have been in their positions for less than two years)
Experienced Staff (individuals who have been in their positions more than two years?)
Partners
Head Start Staff
Early Head Start Staff
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Audio Visual Info & Room Set-Up: R7HSA will provide a LCD projector & screen in each room. Rooms will be set in theatre style seating (chairs only) to accommodate the maximum number of attendees. A resource table will be positioned in the front of each room. Note: Due to budget restrictions, R7HSA does not provide ANY audio equipment or Internet connectivity). Presenters who wish to purchase additional equipment/service, may contact the hotel AV Company directly and make arrangements.
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Alternate seating requested due to presentation of topic
Flip Chart/Markers
Other:
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If Other, Please explain.
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Scheduling: Please indicate the day(s) and preferred session block you are available to present
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Monday, May 21 (reserved for all day-Session Tracks only)
Tuesday, May 22 (Afternoon Session Block only)
Wednesday, May 23
AM (Morning Session Block)
PM (Afternoon Session Block)
Thursday, May 24 (Morning Session Block only)
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Are you willing to repeat this session during the event?
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Yes
No
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Repeat Scheduling: Please indicate if and when you would be available to repeat this session
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Tuesday, May 22 (Afternoon Session Block only)
Wednesday, May 23
AM (Morning Session Block)
PM (Afternoon Session Block)
Thursday, May 24 (Morning Session Block only)
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Language of Presentation
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English
Spanish
Other
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If other language, please explain
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Please include any additional information/credentials you would like to submitt at this time, ie. published works, national affiliations, etc.
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Special Needs: Please indicate if you require special assistance or require special accommodations
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