2006 Conference Speaker Proposal Form
October 12-13, 2006 Myrtle Beach, SC

Check date preferred:

Oct. 12 (Thursday) Oct. 13 (Friday) Either date

Enter number of speakers for session:
If the number of speakers is more than one, enter the last name of the first speaker:

Speaker Contact Information (Name, Affiliation as it will appear in the program)

Speaker Name:
First MI Last

School or Organization

Preferred Mailing Address: Street/P.O. Box		Contact Information: e-mail
City		Work Telephone	Home Telephone
State	- Zip+4	Fax Alternate e-mail

If there is more than one speaker for the session, provide information for each additional speaker below:

Second Speaker Name:
First MI Last

Affiliation

Preferred Mailing Address: Street/P.O. Box		Contact Information: e-mail
City		Work Telephone	Home Telephone
State	- Zip+4	Fax Alternate e-mail

Third Speaker Name:
First MI Last

Affiliation

Preferred Mailing Address: Street/P.O. Box		Contact Information: e-mail
City		Work Telephone	Home Telephone
State	- Zip+4	Fax Alternate e-mail

Session Type (Please check only one):

Session (1 hour) Workshop (90 minutes) Mini-course (3 hours)

Grade Level (check primary level):

PK-Grade 2 Grades 3-5 Grades 6-8 Grades 9-12 College General

Standard (check primary standard):

Number & Operations Geometry Data Analysis & Probability

Algebra Measurement Process Standards

Would you be willing to repeat your presentation? Yes No

Title of Presentation: (Not to exceed 90 characters, including spaces).

Description of Presentation: (Please print or type. Not to exceed 25 words).

Audio-Visual: An overhead projector and one screen will be provided in each room. You may request:

One additional overhead projector and screen and/or VCR/Monitor

NO COMPUTER LABS WILL BE PROVIDED. ANY SPECIALIZED EQUIPMENT OTHER THAN THE ABOVE WILL BE THE RESPONSIBILITY OF THE SPEAKER.

PLEASE SUBMIT BY APRIL 15, 2006