2010 MCAA - Roundtable Proposal Survey

Proposal Deadline is Friday, June 11, 2010!

Contact Information

Contact Information Organizer Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Moderator (if different from above)

Moderator (if different from above) Moderator Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Participant 1

Participant 1 Participant Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Participant 2

Participant 2 Participant Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Participant 3

Participant 3 Participant Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Participant 4

Participant 4 Participant Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Participant 5

Participant 5 Participant Name:
Academic Affiliation:
Address:
Address 2:
City/Town:
State:
ZIP:
Phone Number:
Fax:
Email Address:

Roundtable Title

Outline of the issues to be addressed in the roundtable: (please limit to no more than 300 words)

Technical Support Needs:

Technical Support Needs: Windows Computer

Macintosh Computer

Data & Video Projector (Beamer)

Projection Screen

Overhead Projector for Transparencies

Internet Connection

VHS Video Player

DVD Video Player

Document Camera

Computer Connected Microphone

Computer Connected Speakers

Other (please specify)

Comments or Special Needs: