Wufoo

2009 SCOLT-FLAG-SEALLT Proposal

Please submit proposals here.

2009 SCOLT-FLAG-SEALLT Proposal
March 5-7, 2009: Atlanta, GA
Conference Theme: Empowerment through Collaboration
Deadline for Submission: April 15, 2008

Name * First Last
Home Address: *

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Phone - (###) - ### ####
Email address *
School or Business affliliation:
Work Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Work Phone - (###) - ### ####
FAX
I will need/use the following FREE resources: Overhead projector Screen Pad and markers
I will rent the following: TV and VCR - $ 40 DVD Projector - $ 50
Title (60 characters maximum)
Presentation type: 3 hour workshop 50 minute session 50 minute panel discussion
Description (limit to 80 words):
Check all that apply: All languages French German Latin Spanish Japanese Chinese Other
Check all that apply: Elementary Middle grades Secondary Post secondary Supervisors All levels
My language of presentation is: *
Presenter 2

If you have a second presenter assisting, please have that individual supply the following information:
Name First Last
Home Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Email *
School or Business affiliation
Work Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Work Phone - (###) - ### ####
FAX
Presenter 3

If you have a third presenter assisting, please have that individual supply the following information:
Name First Last
Home Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Home Phone - (###) - ### ####
Email *
School or Business affiliation
Work Address

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Work Phone - (###) - ### ####
FAX
Do Not Fill This Out

Wufoo

2009 SCOLT-FLAG-SEALLT Proposal

Presenter 2

Presenter 3