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Department of Secondary Schools
Convention Proposal Form

* Enter Your Full Name:

* Enter Your Position:

* Enter Your Institution:

* Enter Your Address Line 1:

* Enter Your Address Line 2, if any:

* Enter Your City:

* Enter Your State:

* Enter Your ZIP Code:

* Enter Your Work Phone:

*Enter Your Email Address:

What is the proposed title of your session?

Please provide a session outline (purpose,

content and main points, outcomes):

Please provide speaker qualifications:

Please provide an abstract of your talk (3-5 sentences):

* Are you planning to have a co-speaker?

Yes      No

Please provide contact information for your co-speaker including email address: