REQUEST TO PARTICIPATE FORM

PLEASE READ THE FOLLOWING: -

* marked fields are REQUIRED.

Presentation Information

Department*
Title of Presentation*
First Name*
Last Name*
  Note: Room for additional presenters at the end of the form

Contact Information

Name*
Phone Number*
Address*
Email*
You are a?* Student Faculty
Only Students*  Sponsor Name*
  Sponsor Phone*
  Sponsor Address*
  Sponsor Email*
Only Faculty*  Willing to chair your and/or
  students' presentation?* Yes No

Presentation Description

Presentation Type*
 If Other, please specify
If not a paper or poster indicate the amount of time needed

Audio Visual Needs - Check ONLY IF applicable

Overhead Projector
35mm projector
VCR 1/2" 3/4"
Other Needs

Computer Related Information

Need a computer? Yes No
Operating System
Software (include version#, please note we might not be able to provide it)
  Note: Art students/faculty must get their own supplies

Support - Faculty Only

Did the research recieve a Faculty
Enhancement Grant?* Yes No

Abstract

Note: Should be less than 100 words. Do NOT use any special Characters

characters left
Dont see your abstract? Click Here.

Additional Presenters - List upto fourteen addtional presenters

First Name Last Name

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Created by
Anshul Agrawal - 2005