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Please provide us the following information:

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* 1. What District, Section, or Chapter are you representing?

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* 2. What is the title of your presentation?

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* 3. How long do you think your presentation will be?

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* 4. Please provide a brief description of the program

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* 5. Audience - mark all you think may apply

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* 6. Any idea how many participants you would expect to attend?

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* 7. Presentation:

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* 8. How many speakers?

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* 9. Will you require a question and answer period?

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* 10. Will you have a moderator?

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* 11. What capabilities are needed for your meeting/presentation? Mark all you think may apply

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* 12. Would you like to be able to provide professional development hours credit to this presentation?

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* 13. Do you require a recording?

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* 14. What are 3 potential dates and times that would be ideal for you planning wise?

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* 15. Please provide your name

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* 16. Please provide your email address

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