NAKPEHE
PROPOSAL SUBMISSION FORM


The NAKPEHE National Conference

Marriott Suites on Sand Key, Clearwater, Fl
January 3-6, 2007

Deadline for proposal submission: September 15, 2006
What is your first name?
What is your last name?
E-mail Address

To propose a program for the 2006 NAKPEHE Conference, provide the following information.

1. Title of proposed program:

2. For consideration submit a 500 word summary of your proposed program:

3. Speaker Name:
Street Address:
City: State Zip
School/Business Affiliation:
Work City: State Work Zip
Phone (W): Phone (H): Phone (Fax):

3a. Additional Speaker Name:
3aa. Additional Speaker Affiliation:

3b. Additional Speaker Name:
3bb. Additional Speaker Affiliation:

3c. Additional Speaker Name:
3cc. Additional Speaker Affiliation:

Please note: Only speakers who register for the conference will be cited in the Conference Program.

4a Will you be bringing a computer for your presentation?
Yes No

4b Will you be bringing an LCD projector for your presentation?
Yes No

5. If yes, are you willing to permit others to use your equipment?
Yes No

Any changes to your proposal should be addressed to [email protected]. Questions? 940.898.2852.

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