Part
I
WORKSHOP
LEADER'S INFORMATION
Last
Name:
First
Name:
Phone:
Address:
City:
State:
Zip:
E-Mail:
Fax
Number:
When
is the best time for us to reach you?
How do you
prefer that we contact you?
Bio
- Please
give a brief description of your career and background.
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Sample Response
CO-WORKSHOP
LEADER'S INFORMATION
Last
Name:
First
Name:
Address:
City:
State:
Zip:
Phone:
E-Mail
Address:
Fax
Number:
How
should we contact your co-leader?
Bio
- Please
give a brief description of your career/background.
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Sample Response
WORKSHOP
INFORMATION
Workshop
Title
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Response
Career What is the career category for your workshop? Examples:
Workshop
Description Briefly describe your workshop.
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Response
Session
Information
Which
sessions can you present? Please check all that
apply. (Times are
tentative)
Would you like to attend a
session on how to lead a workshop?
Yes
Part
II
FACILITY,
EQUIPMENT, & OTHER REQUIREMENTS
Classroom
Requirements What
type of room do you need for your workshop?
Other:
Equipment
Requirements
Please indicate only those items
you will really need to facilitate proper planning. Audio/Visual & Other Equipment
Laboratory Equipment Requirements
Other A/V, Laboratory, or
General Equipment Requirements
Not
sure what equipment is needed at this time
Volunteers Would
you like EYH to provide volunteers to help with your workshop?
Other
Information Is
there anything else you would like us to know?
