2008 PAEA Annual Education Forum Expert Panel Presentation Submission Form

Please complete and submit this form by midnight, June 22, 2008.

* Title of Expert Panel Presentation:

Panel Presenters/Facilitator(s) minimum of 3, maximum of 5 (must include academic and professional credentials and complete contact information. Each presenter must also include statement as to why he/she is an expert in proposed topic of presentation)

Presenter #1 (Name, Contact Information and Credentials):

Statement of Expertise:

Presenter #2 (Name, Contact Information and Credentials):

Statement of Expertise:

Presenter #3 (Name, Contact Information and Credentials):

Statement of Expertise:

Presenter #4 (Name, Contact Information and Credentials):

Statement of Expertise:

Presenter #5 (Name, Contact Information and Credentials):

Statement of Expertise:

Primary contact (person to receive confirmation of material):

* Last Name

* First Name

* Credentials

* Institution

* Address

Address 2

* City

* State

* Zip Code

* Phone

* E-mail

* Educational goals and objectives (These should take the following format: "At the conclusion of this session, participants will be able to...")

* Description of session: This must follow format as outlined in the description and include a timeline of activities.

* References: (a maximum of the 5 major references only) (for format information, click here)

* Target Audience

Presentation rooms will be equipped with:
* IBM-compatible laptop computer with Microsoft XP including PowerPoint and software/hardware to accept presentation on USB drive or on a CD
* LCD data projector and screen
* Microphone(s)

Please indicate if other AV equipment or supplies are required (Additional equipment supplied pending approval by PAEA).

* Indicates Response Required