Workshop Presenter Interest Form
Print and complete this form to express your interest in presenting a workshop at the May 29 and 30, 2008 Conference to be held at the Northwestern University Law School in Chicago.
Name:_____________________________________________
Title:_____________________________________________
Organization:_____________________________________
(if your organization sells products and services see the sponsor
agreement below)
Address:__________________________________________
City:_________________State:________Zip:__________
Phone:_______________________
Fax:_________________________
Website:__________________________________________
E-mail:___________________________________________
Please proved the following information (use a separate page as needed):
1. Proposed Workshop Title (subject to editing by T/MC)
_________________________________________________________________
2. Session Description—Please provide a clear, concise 50 word summary that tells participants what to expect from the workshoip. This will be used on the conference web site, invitation and program book.
3. Provide a detailed description of your workshop, who it is intended to serve (leaders, volunteers, etc.) and one or two lessons they might expect to take away from the workshop.
4. Provide a brief (100 word maximum) biography of each presenter and the organization you represent. If you or your organization are selling products and services, please review the sponsor agreement below.
5. What level of experience does this presentation address:
_____ Beginner _____ Advanced _____ both
6. If your workshop is focused on organizations working with specific age groups, please indicate which age levels the workshop targets:
Grade levels: _____ K-5 _____ 6-8 _____ 9-12
7. Audio Visual Needs: Please check only those items necessary for your presentation. The T/MC will make every effort to meet your request, but may need to discuss unusual requests on a case-by-case basis.
_____ No equipment needed _____ Flip chart and pens
_____ Overhead projector and screen _____ Carousel slide projector
_____ VCR and monitor _____ LCD Projector ______ Laptop
NOTE: T/MC has only limited capacity to respond to requests for LCD
projectors and laptop computers. If you are not able to provide your
own LCD projector, contact T/MC for further guidance.
Presenter Release
By completing and submitting this form, I am agreeing to the following:
I agree that any photos taken of me during this event can be used on the Internet to help T/MC promote future conferences and tutoring/mentoring
I agree that my workshop can be video taped, and that parts or all of the video can be put on the Internet for promotional, educational or motivational use
Upon acceptance of this proposal, the Tutor/Mentor Connection is hereby authorized to record and/or publish and sell a conference handbook and/or a conference CD, that includes any material presented during this session at the May 29 and 30,2008 Tutor/Mentor Leadership Conference or eConference Overlay.
______ I DO NOT agree to have sessions recorded or materials republished or distributed by the Tutor/Mentor Connection or any other participant in this conference.
Signature of Primary Presenter
__________________________________________________Date ________________
Vendor Workshops
The conference will offer 5 to 7 workshops in each workshop time slot (4 per day). Only one of these time slots will be reserved for vendors. To present a workshop in this time slot you will need to pay a $500 sponsor fee. This will give you a workshop slot, a display table (if you want one) and a 1/2 page add in the Conference Program. Please submit your sponsor fee once you receive confirmation that your workshop proposal has been accepted.
______________________________________________________
Name/Organization/Date
I agree to the sponsor fee of $500 and will submit my payment once my workshop is approved.
Please mail or fax to:
Tutor/Mentor Connection
800 W. Huron
Chicago, IL 60622
Fax 312-492-9795
