ANTSHE National Conference
April 5-7, 2002

Please type the following information:
Session Title (maximum 10 words):                                                                                                                  

Please attach a separate sheet with an outline of your presentation.

Format (Check all that apply):            __  Lecture Panel                        __  Roundtable

                                                                __  Discussion                            __  Audio-visual           __  Audience Participation

__    Other:                                 

Target Audience:                 __  Undergraduate Students                      __  Graduate Students                __  Faculty

                                __  Community College   __  College/University    __  All                __  Other:                               

Lead Presenter:

Name:                                                                                       Title:                                                                                      

Institution:                                                                                                                                                                           

Mailing Address:                                                                                                                                                                

Phone Number:                                       Fax:                                                         Email:                                                     

Co-Presenter(s):

 Name:                                                                                       Title:                                                                                      

Institution:                                                                              Phone:                                      Email:                                   

Name:                                                                                       Title:                                                                                      

Institution:                                                                              Phone:                                      Email:                                   

Program Summary (50-60 words), to be used in Conference Program:

Audio-Visual Equipment:  (due to the extremely high rental fees, and in order to keep conference costs to a 
minimum, we request that you ask only for the equipment you will absolutely need.  Thank you for your cooperation.)

__   Overhead Projector                __  Slide Projector                  __  VCR/TV Monitor

__   LCD Projector                          __  None                                  __  Other:                                                               

Should this program be selected I/We agree that:

1. All presenters agree to pay full conference registration fees
2. I (with my co-presenters) am responsible for all printed materials for this session.

Contact Person Signature:                                                                                                              Date:                                      

DEADLINE:  January 15, 2002