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 Presenters:

Please leave this field empty.

Have you contacted your co-presenter(s) already?
YesNo

Have they agreed to be co-presenters?
YesNo

Would you like help finding possible co-presenters?
YesNo

Type of Presentation (required):
Session (1 hour)Seminar (2 hours)

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

Please leave this field empty.

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

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

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Audi/Visual Equipment Needed (required):
LCD ProjectorWhite Board or Flip ChartMicrophoneNone

Security Code

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