Roundtable Proposal

Title of Proposed Roundtable  
Abstract for Roundtable (150-250 words)  
Name of Chair  
Primary affiliation  
Chair's Background for Topic (brief summary)  
   
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  
Scheduling constraints (if any)  
Special needs (if any)  
Other comments (if any)  


Participant 1

Name(s)  
Primary affiliation(s)  
Participant's Background for Topic (brief summary)  
  
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  
  Audiovisual needs (if any)   
  PowerPoint
  Audio for PowerPoint
  Microphone
  Overhead Projector
  Dry Erase Board
  Flip Chart with Markers
  Other  
Scheduling contraints (if any)  
Special needs (if any)  
Other comments (if any)  


Participant 2

Name(s)  
Primary affiliation(s)  
Participant's Background for Topic (brief summary)  
  
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  
  Audiovisual needs (if any)   
  PowerPoint
  Audio for PowerPoint
  Microphone
  Overhead Projector
  Dry Erase Board
  Flip Chart with Markers
  Other  
Scheduling contraints (if any)  
Special needs (if any)  
Other comments (if any)  


Participant 3

Name(s)  
Primary affiliation(s)  
Participant's Background for Topic (brief summary)  
  
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  
  Audiovisual needs (if any)   
  PowerPoint
  Audio for PowerPoint
  Microphone
  Overhead Projector
  Dry Erase Board
  Flip Chart with Markers
  Other  
Scheduling contraints (if any)  
Special needs (if any)  
Other comments (if any)  


Participant 4

(With panel sessions of only an hour and a half, a roundtable with an active chair should probably be limited to no more than three other participants, and surely no more than four)
Name(s)  
Primary affiliation(s)  
Participant's Background for Topic (brief summary)  
  
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  
  Audiovisual needs (if any)   
  PowerPoint
  Audio for PowerPoint
  Microphone
  Overhead Projector
  Dry Erase Board
  Flip Chart with Markers
  Other  
Scheduling contraints (if any)  
Special needs (if any)  
Other comments (if any)