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* 1. Name-List lead presenter first

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* 2. Job Title

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* 3. Organization/Site

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* 4. Phone

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* 5. Email

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* 6. Co presenter(s) information (Name, Title, Site, contact info)

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* 7. Title of Session

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* 8. Please provide a brief description of your session (250 words or less) that includes the following information:

1) Theme

2) Objectives

3) Content

4) Mode of delivery (Lecture, hands on, panel discussion, outside, etc.)

5) Impact to participants (desired outcome for participants)

6) Maximum # of participants (if any)

7) A short summary statement to include in the itinerary documents if selected to present.

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* 9. The length of this session will be

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* 10. What will you need us to furnish for your session?  Check all that apply.

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