Name of Person Submitting:  ________________________________________

Organization:  ______________________________________________________

Mailing Address:  ___________________________________________________

City, State, Zip Code:  _______________________________________________

E-mail:  _____________________________________________________________

Telephone:  _______________________      Fax:  _________________________
 

Type of Presentation:

__ Research Brief (15 minutes)            __ Practice Cameo (15minutes)

__ Hour-Long Practice Cameo              __ Hour-Long Research Brief

__ Hour-Long Research Brief and Practice Cameo

__ Poster Session*

*Undergraduate and graduate student poster submissions should be accompanied with the name of a sponsoring faculty member.  Monetary prizes will be awarded to the top three student posters.

Audio Visual Request:  ______________________________________________

Presenter(s) Names:  _______________________________________________

____________________________________________________________________

Title of Proposed Presentation:  _____________________________________

____________________________________________________________________

Abstract of Proposed Presentation:  (250 word limit)