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MSTA Annual Conference – Presenter Form For speediest results, please copy the text of this form into an e-mail, fill it out and send it to Robin Kennedy:
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Thank you for your patience and persistence. MSTA Annual Conference – Presenter Form Taking the Mystery Out of Science and Literacy October 9th, 2009 at Gardiner Area High School **If you are accepted as a presenter, you do not need to register for the conference**
Name _______________________________________ Position_________________________________________ Home Address ________________________________________________________________________________ City/Town _______________________________________________ State ___________Zip ______________ Home Phone _____________________ School/Organization ____________________________________________________________________________ Address ______________________________________________________________________________________ City/Town ________________________________________________ State ___________Zip _____________ Work Phone ___________________ * Email______________________________________ Preferred mailing address: [ ] home [ ] organization (MSTA newsletters will be sent to you via email during the coming year.)
Describe your organization: [ ] private school [ ] public school [ ] informal educational institution
[ ] K-2 [ ] 3-4 [ ] 5-8 [ ] high school [ ] college [ ] pre-service
Presentation Information Type: [ ] Session - 1 hour [ ] Workshop - 2 ½ hours
Target Audience/Grade Level(s): ________________________________
If the presentation is professional development, check the appropriate content area(s): [ ] Life Science [ ] Physical Science [ ] Earth/Space Science [ ] Any
Title ________________________________________________________________________ ____________________________________________________________________________
Co – Presenter(s) ______________________________________________________________ (Attach a presenter form with contact information for each presenter. If more than two are presenting, food costs will need to be paid for the additional presenters at registration.)
Needs: Requests should be an integral part of your presentation. [ ] Water [ ] Tables ***It would be helpful if you could bring your own AV equipment. However, if your presentation requires a computer lab (PC or MAC) or any other equipment, please contact us at least two weeks before the conference!
1. Electronically provide a brief (50 words or less) description of your presentation. This description will appear in the program. Please email your description to Sharon Gallant at
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2. Send presenter form electronically or mail it to: Robin Kennedy 30 Venture Way Bangor, Maine 04401 Please contact Robin Kennedy at
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for further presenter information. Please fill out one form for each presentation!
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