Conference Program / Meeting Proposal Form

2010 WLA Annual Conference
Parkway Plaza, Casper, Wyoming
September 29 – October 2, 2010

Deadline: March 1, 2010

Instructions: Submit a separate form for each program you are proposing. Obtain all the information necessary to submit a complete and accurate proposal before you begin filling out this form.

FYI: Though an Internet connection is available for program sessions connectivity cannot be guaranteed at the time of or during a presentation. We highly recommend that you bring alternative formats for your presentation.

All fields marked with * are required.

Contact Information

What is your Name: *

What is your Email Address: *

What is your day-time telephone number:

Program Information

Title of your program: *

Provide a brief (Maximum 240 characters) description of program content, purpose, and objectives:

[Note: What you provide below will be the description that appears in the conference program.]

Presentation Format: Single speaker
Multiple speakers
Panel discussion
Demonstration

Program Type: 1 hour Conference Session
2 hour Conference Session
3+ hour Pre or Post Conference Session

Do you require two consecutive time slots to provide for discussion following the presentation:
Yes
No

Preferred Program Date(s):

Wednesday, September 29 (Pre-conference)
Thursday, September 30
Friday, October 1
Saturday, October 2 (Post-conference)

WLA Section/Sponsor for this program:

Program Track:

Additional comments or information to accompany your proposal (Maximum 240 characters):

Speaker(s) Personal Information

Provide the following information each speaker.

Speaker Number 1:

Name:

Title:

Institution:

Email Address:

Home Mailing Address:

Daytime Phone Number:

Speaker Number 2:

Name:

Title:

Institution:

Email Address:

Home Mailing Address:

Daytime Phone Number:

Speaker Number 3:

Name:

Title:

Institution:

Email Address:

Home Mailing Address:

Daytime Phone Number:

Speaker Number 4:

Name:

Title:

Institution:

Email Address:

Home Mailing Address:

Daytime Phone Number:

If more than 4 speakers, please list them below::

Do you wish to schedule a business meeting with this program: Before
After
No

Compensation Request

[NOTE: Only speakers not affiliated with WLA are given financial compensation.]

Speaker fee/honorarium:

Travel:

Lodging:

Meals:

TOTAL:

Matching funds amount:

Source of matching funds::

Facilities and Equipment

Room Set Up Classroom (with tables)
Theater (without tables and one podium for speaker)
Theater with Panel Discussion (tablefor multiple speakers)
Discussion room (tables arranged for small groups)
Other

Equipment Needs

[ NOTE: WLA cannot provide computers or software for presentations. It is up to the speaker/sponsor of the program to do so and to ensure their equipment is compatible with any equipment or internet connection provided at the conference facility. Though Internet access is available, there is no guarantee regarding connectivity or speed. Each meeting room is equipped with a single lavaliere microphone and/or single handheld microphone with stand, and a projection screen.]

Absolutely no equipment needed for this presentation, including projection equipment or computer access.

It is expected that your request will reflect "actual" rather than "supposed" needs. Which of the following items will definitely be used during the presentation of this program:

Will you need an internet connection for your presentation? Yes
No

Which of the following, if any, do you or the speaker intend to bring for use in this program? Laptop computer
LCD computer projector
CD player
DVD player
VCR player
Other:

Do you or the speaker need audio projection from above device(s) for the audience? Yes
No

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Thank you for submitting this proposal!

We look forward to seeing you in Casper!