"Wiggle, Giggle, & Learn"

All form items are required unless labeled "optional."

1. Title of Presentation
   
   
    
2. Major Presenter
   
   Name:
   
   Position/Title:
   
   District/Affiliation:
   
   Home Address:
   
   City:      State:      Zip:
   
   Home Telephone:
   
   Work Telephone:
   
   E-mail Address:
    
3. Additional Presenters (optional)
   
   Include name, address, phone, and district/affiliation for each additional presenter (optional).
    
   
    
4. Type of Program
   
   Panel
    
   Demonstration
    
   Lecture/Talk
    
   Please specify if other:
    
5. Intended Audience
   
   Clientele are 2 years old or younger
   
   Clientele are between the ages of 3 years and 6 years
   
   Clientele are 7 years old or older
   
   Program development
    
6. Room Setup (optional)
   
   Classrooms are set up with tables and chairs and have high-tech capabilities. Please select technology needs from the following:
   
   Computer with Projector Document Camera DVD Player VCR
   
   Rooms do not have sinks. We will try to accommodate your requests. Please describe an alternative setup if needed.
    
   
    
7. Number of Sessions
    
   Please indicate the sessions in which you wish to present. Multiple/repeated sessions are encouraged. Please note that times are approximate and may change as we continue to plan the conference.
   
   Session A (9:45 AM to 11:00 AM)
   
   Session B (12:45 PM to 2:00 PM)
   
   Session C (2:15 PM to 3:30 PM)
    
8. Description
   
   Please provide a description which clearly explains the content of your presentation and emphasizes what participants will learn in no more than 35 words.  If you are providing take-home resources, please refer to them in your description. Word it as you would like it to appear in the conference brochure—this will help participants choose the workshops that fit their needs.
   
   
    
9. Handouts
   
   Handouts are the responsibility of presenters. We will let you know how many people are registered for your workshop at least one week before the conference so that you have time to prepare your handouts.
    
   
10. Biography - This will be used to introduce you during your session.
    
    Please provide a 5-10 sentence biography including your education and professional experience.
    
    
     
11. Workshop Size
    
    Please indicate the audience size with which you are most comfortable.
    
    30 or fewer
    
    30 - 50
    
    50 - 75
    
    Please specify if other:
     
12. Categories
    
    For registry labels, which core topic areas best describe your presentation?
    
    

    Child Development (DEV) Developmentally Appropriate Practices (DAP) Guidance (GUI) Professionalism (PRO) Finance (FIN) Marketing (MAR) Regulatory Policy and Standards (REG) Personnel Management (PER)

    Cultural & Individual Diversity (DIV) Family Relationships (FAM) Observation & Assessment (OBS) Safety & Healthy Environment (SAF) Legal (LEG) Organizational Management (ORG) Adult Education (AED)

    
    
13. Compensation
    
    Please indicate your preference for a complimentary conference registration or honorarium, as a token of our appreciation for taking the time to present at our conference. Major program presenters may choose one of the following:
    
    Complimentary conference registration
         (includes materials, refreshments, lunch, workshops, and keynote addresses)
    
    $50 honorarium
    
    Waive compensation
         (Thank you for helping to support the conference!)
    
    Note: Additional presenters will receive a complimentary conference registration.
     
14. Additional Comments (optional)