General Information about your Symposium Proposal

Symposium Title:

*

Brief description of the symposium:

*

Audience : (College, High School, Middle School, General Audience, or any combination)

Time allowed for each presentation : (20 or 25 minutes)

Symposium Organizer Information

First Name: *

Last Name: *

E-mail Address: *

Institution Affiliation: *

Department: *

City: *

State: *

ZIP: *

Phone Number: *

FAX#:

Country: *

Symposium Co-organizer Information

First Name:

Last Name:

E-mail Address:

Institution Affiliation:

Department:

City:

State:

ZIP:

Phone Number:

FAX#:

Country:

Symposium Presider Information

( Check here if the presider is the same as the Symposium organizer.

Check here if the presider is the same as the Symposium co-organizer. )

First Name:

Last Name:

E-mail Address:

Institution Affiliation:

Department:

City:

State:

ZIP:

Phone Number:

FAX#:

Country:

Symposium Presenter Information (at least one individual who has agreed to participate in your symposia (other than the organizer or presider).)

First Name:

Last Name:

E-mail Address:

Institution Affiliation:

Potential restrictions (if any): number of presenters, day, type of room, lecture demonstration facilities, multimedia needs, etc.:

Potential problems :