Name:

Email:

Phone:

Department:

Session Title:

Session Description:     

Teaching Assistants       Research Assistants  
Admin. Assistants           International Students     
Faculty                               General Audience            

Preferred Date

Select which date or dates that apply:

 August 19        August 20       August 21

Ongoing Program Fall Date: 

Ongoing Program Spring Date: 

Time preference
(select all that apply)

8:30 - 9:30 AM 9:45 - 10:45 AM

9:45 AM - 12:00 PM  11:00 AM - 12:00 PM

Other time:

 Location Preference

 
 (ex:. computer lab, classroom)

Any A/V or Computer needs:

No      Yes     Select all that apply

Flip Chart        TV/VCR      Video Presenter
PC w/PowerPoint          PC w/Web Access     
MAC w/PowerPoint      MAC w/Web Access

For computer users, please select preferred drive format:
CD Rom        3.5"      Zip Drive        USB for Flash Drive

Other requirements:        

Any Suggestions: