Workshop Presenter Interest Form
Print and complete this form to express your interest in presenting a workshop or participating in a panel at the May 27 and 28, 2010 Conference to be held at the Loyola University Chicago's Lakeshore campus.
Name:_____________________________________________
Title:_____________________________________________
Organization:_____________________________________
(if your organization sells products and services see the
Vendor workshop information 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 workshop. 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 parts of my workshop can be video taped, and that such video can be put on the Internet for promotional, educational or motivational use. T/MC will not make video copies of more than a few minutes of any speaker's presentation.
Signature of Primary Presenter
__________________________________________________Date ________________
Vendor Workshops
During each conference a few vendors are invited to present workshops that
showcase services they are selling. A $500 fee is charged to vendors and we
clearly notify conference participants that this is a "vendor workshop" so they
are aware that you are promoting your own services. If you would like to present
a workshop under this condition, please submit this form.
__ I agree to this and my $500 donation is attached, or in the mail.
Please mail or fax to:
Tutor/Mentor Connection
800 W. Huron
Chicago, IL 60642
Fax 312-492-9795
