Title: 

Author(s):

First Author's Name

Affiliation (Academic or Business)

Would you be willing to Chair a session?

Yes No

Second Author's Name

Affiliation (Academic or Business)

Would you be willing to Chair a session?

Yes No

Third Author's Name

Affiliation (Academic or Business)

Would you be willing to Chair a session?

Yes No

Other Authors' Names and Affiliations

Please provide the following contact information:

Name
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
E-mail

Time requested for presentation (check one)

15 minutes
20 minutes
25 minutes
30 minutes

Equipment needed (check all which apply)

Overhead projector        Slide projector           Video player              Computer image projector
Blackboard                

Other equipment needed or special requests