STANYS 115th Annual Conference
Workshop Proposal Form

November 6-9, 2010, Rochester Conference Center - Rochester, NY
 
Work shops will be scheduled for Nov 7-9
 
Please complete this form by May 16, 2010.

Please print a completed copy of this form for your records
(you will have the option to print at the end of the form submission process.)

For additional information, email James Overhiser at joverhis@twcny.rr.com

* Fields labeled in red are required!
Name (Main Contact):
First Name: Last:
Presenter and Contact:
Contact Only: 		Enter the number of additional presenters:

  NOTE: Limit of 10. If more needed,
     contact joverhis@twcny.rr.com
Home Address: Work Address:
Home City:
Home State:       Home ZIP: 		Work City:
Work State:        Work ZIP:
Home Phone (xxx-xxx-xxxx): Work Phone (xxx-xxx-xxxx):
EMAIL: FAX:
Professional Organization/School/Company:
Title of Presentation (15 words or less):
Brief description of presentation (40 words or less):