Balanced Mind - Proposal To Present
 

1. Presenter Information

 
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Tell us who you are and provide us with contact information

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1. Salutation

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2. First Name

3. Middle Name or Initial

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4. Last Name

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5. School or Organization Affiliation

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6. Title or Position

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7. Phone Number (summer)

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8. Phone Number 2 (cell)

9. Additional Phone Number (optional)

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10. Email Address 1

11. Email Address 2 (optional)

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12. Home Address

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13. Town

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14. State

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15. Zip Code

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16. Title of Proposed Session

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17. Discipline(s)That This Session Will Address

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18. To which level(s) is this presentation aimed?

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19. Will students be involved in the presentation?

20. If so, how many?

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21. Please provide us with a biography (paragraph style,written in 3rd person) that briefly outlines your background, experience, honors and awards.

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22. Have you presented at a Balanced Mind Conference in the Past?

23. If so, When?

24. Please provide Name(s) of Additional Presenter(s)If Any.
(Note - You will be the primary contact and will be the only one receiving notices)