PIEA Speaker Proposal Form

PIEA Speaker
Proposal Form
Use this form to submit a proposal for the next PIEA Education Conference.

The 2011 Conference will be in Las Vegas, NV, Jan 30 - Feb 2, 2011.

Use tab to move between fields. Print when complete.
Hitting the Submit button will e-mail a copy to consultant@pieapma.org.

NAME

Title
First Last

Address

City State Country
ZIP

E-mail

Phone

SCHOOL/
BUSINESS

Address

City State Country
ZIP

E-mail

Phone

Title of presentation:
(eight words or less)

Publication Description: (Write a short, two-to-three sentence description of your session. Maximum 75 words.)

Additional Explanation: (If you'd like to provide additional information about your presentation, you may put it here, but it will not appear in publication.)

The appropriate audience is:
high school students college students all students educators all

Time Required
(How much time do you need for your presentation?
This total should include time for question and answer.)

15 minutes
30 minutes
45 minutes
60 minutes

Biographical Information: (100 words or less in sentence style, please. Provide biographical information for each speaker if team teaching.)

Enter Letters or Numbers displayed in the box above here.

PRINT A COPY FOR YOUR RECORDS
then click SUBMIT to send a copy to PIEA.

You will be contacted to let you know if your proposal has been accepted.

I acknowledge that speakers are expected to provide a summary page or a copy of the presentation in PDF form to include in the members' area of the PIEA website.