Conference Speaker Questionnaire

Thank you for agreeing to serve as a speaker at the 2006 CASE District III Conference in Nashville. We appreciate your time and participation and are looking forward to seeing you in February.

The Conference Committee is dedicated to ensuring that you have everything you need to make your presentation a success. In order to ensure everything runs smoothly, we ask that you please take a few moments to complete this questionnaire. This information will assist us as we move forward in the planning process. The hotel will provide podiums in each room. However, no audio/visual items will be furnished unless requested by the speaker.
Thank you again and "We'll C- ya in Nashville

SPEAKER INFORMATION
Name:
Title:
Institution/Company
Address
City:
State:
Zip:
Phone:
Fax:
Email:
Please Provide a Brief Biography:

SESSION INFORMATION
Session Title:
Session Description:

AUDIO VISUAL REQUESTS Please take a moment to complete the form below to indicate what, if any audio-visual needs you have that are critical to your presentation. Please be aware if using a PowerPoint presentation, the speaker MUST provide their own computer. Also please keep in mind that we must absorb the rental cost of these items. Therefore, when making your selections, please be considerate and only request items that are essential to your presentation. We thank you for your willingness to help make the 2006 CASE District III conference a success and we appreciate your efforts in helping us to control costs. Thank you once again! PLEASE READ CAREFULLY: Please mark the items you feel are vital to your presentation. If more than one of an item is needed, please indicate the number needed.
	Quantity Needed
. Flip Chart With Marker
. Handheld Microphone (wireless needed?) yes no)
. Lapel Microphone (wireless needed?) yes no)
. Multiple Table Mics for Panel
. Overhead Projector
. Podium Microphone
. VCR unit w/ TV monitor

PREMIUM ITEMS Please do not request these items unless absolutely necessary for your presentation.
. Internet Connection
. PowerPoint (LCD) projector with screen

Special Requests/Comments:

Conference Speaker Questionnaire

SPEAKER INFORMATION

SESSION INFORMATION

AUDIO VISUAL REQUESTS

PLEASE READ CAREFULLY: Please mark the items you feel are vital to your presentation. If more than one of an item is needed, please indicate the number needed.

**PREMIUM ITEMS**

Please do not request these items unless absolutely necessary for your presentation.

PLEASE READ CAREFULLY:
Please mark the items you feel are vital to your presentation.
If more than one of an item is needed, please indicate the number needed.

PREMIUM ITEMS