Call for Presenters - Online Form

Presenters

Presenter #1

Name:
School/Agency:

Presenter #2

Name:
School/Agency:

Presenter #3

Name:
School/Agency:

Presentation Information Proposed Title:
Health or Physical Education VA SOL & Grade Level:
Brief Description of the Presentation (for the program): 75 words or less
Presentation Format:

Lecture

Round Table Discussion

Activity

Resources Needed:

Lecture Room

Space for Activity

Computer Lab

Outdoor Area

Audio/Visual Needs:

PowerPoint

Networked Computer

VCR/DVD

Time Needed:

50 Minute Session

75 Minute Session

Contact Information Contact Person:
Address (line 1):
Address (line 2):
City:
State:
Zip:
Fax:
Home Phone:
Office Phone:
Email:

Accommodations Will you need on-site accommodations?

Yes

Please specify the night(s):

Sunday

Monday

Tuesday

Wednesday