Paper Proposal

Title of Proposed Presentation   
Name(s)   
Primary affiliation(s)   
   
Mailing address    
  Line 1   
  Line 2   
  Line 3   
City   
State/Province   
Zip/Postal Code   
Country   
Work phone   
Cell or Home phone   
E-mail address   
E-mail address confirmation   
Abstract (150-250 words)   
Audiovisual needs (if any)   
  PowerPoint
  Audio for PowerPoint
  Microphone
  Overhead Projector
  Dry Erase Board
  Flip Chart with Markers
  Other  
Scheduling constraints (if any)   
Special needs (if any)   
Other comments (if any)