You are invited to share your ideas as a workshop presenter at the 2007 PMSA State Conference.  If you are interested in making a presentation, please complete the following application and mail or fax it by Dec 1, 2006 to:

 

 

 

 

All presenters must register to attend the conference.  PLEASE TYPE OR PRINT your application

PRESENTATION TITLE                                                                                                                                                     

NAME                                                                                                                         Circle:  Dr.   Mr.   Mrs.   Ms.   Miss

                  (Last)                                                   (First)

POSITION                                                                                                                                GRADE  __________________

NUMBER OF CO-PRESENTERS:  ___________ 

Æ PLEASE ATTACH A SEPARATE SHEET WITH ALL CO-PRESENTER NAMES & ADDRESSES           

 

SCHOOL NAME & ADDRESS                                                           HOME ADDRESS 

                                                                                                                                                                                     

                                                                                                                                                                                     

                                                                                                                                                                                     

PHONE                                                                                            PHONE                                                                 

FAX                                                                                    

EMAIL                                                                                 

 

ABSTRACT:  In 50 words or less, READY FOR PUBLICATION, summarize the content of the presentation.  Include major emphasis, objectives, and activities that will be presented.

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       

AUDIO – VISUALS  (check needed equipment – THIS EQUIPMENT WILL BE PROVIDED AT NO ADDITIONAL CHARGE BY PMSA AS A COURTESY TO OUR PRESENTERS)

 

SCREEN                                       OVERHEAD PROJECTOR                                     TV/VCR                         

Mr. Dave Dolbin

100 Jakes Lane

Warriors Mark, PA 16877

(814) 692-8220    FAX (814) 272-8557

Email:  ddolbin@gmail.com