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Speaker/Program Form
New Hampshire Educational Media Association Conference May 13 & 14, 2008 Radisson Hotel, Nashua Contact Information: Pam Tinker, Conference Chair Email: pamalaj.tinker@merrimack.k12.nh.us For AV questions, Pam Harland at pharland@pemi-baker.sau48.k12.nh.us Other Information: Please supply 100 handouts and electronic format (PowerPoint, Word, or html for website)
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Name: 


A red asterisk (*) indicates required questions.

  1. Program Title*


  1. Description for Program Brochure*


  1. Job Title*


  1. Library/Organization*


  1. Address*


  1. Work Phone*


  1. Home Phone*


  1. Cell Phone*


  1. E-mail Address*


  1. FAX*


  1. Additional Speakers - Please list names, job title, library/organization, address, work phone, home phone, email, fax


  1. Program Length:*
    1 hr
    1.5 hr
    2 hr


  1. Are you willing to offer this program more than once?*
    Yes
    No


  1. Who is the intended audience? (Check all that apply)*
    Elementary
    Middle
    High


  1. Check ALL the boxes you are AVAILABLE to present (Committee will make final assignments):*
    Tuesday AM
    Tuesday PM
    Weds AM
    Weds PM


  1. What audio-visual equipment do you need for the program committee to supply? What audio-visual equipment do you plan to bring? (For AV questions, contact Pam Harland at pharland@pemi-baker.sau48.k12.nh.us)*


  1. If you have been working with someone from NHEMA, please include his/her name:


  1. Additional Comments: