Conference Proposal Form

Your Name (required):

Working Title of Presentation (required):

Name of Primary Presenter (required):

Affiliation:
ASIISC/SCIOther

Your Address (required):

Your Address 2:

Your City (required):

Your State/Province (required):

Your ZIP/Postal Code (required):

Your Country (required):

Telephone (required):

Your Email (required):

Additional Presenter:

Please leave this field empty.

Have you contacted your co-presenter already?
YesNo

Have they agreed to be a co-presenter?
YesNo

Would you like help finding a possible co-presenter?
YesNo

Description: Abstract--please limit to 100 words (required):

Please leave this field empty.

Biographical Statement about Primary Presenter--please limit to 100 words (required):

Please leave this field empty.

Biographical Statement about Confirmed Copresenter--please limit to 100 words (required):

Please leave this field empty.

Audio/Visual Equipment You Use (required):
Powerpoint or other presentation programHard-wired internet connectionWebcamMicrophoneNone

Security Code

Please type the Security Code shown above in the box above.
Note: the characters are case-sensitive
Please leave this field empty.