APTAC
SPEAKER INFORMATION FORM


Please provide the following  information:
Hit the submit key when finished

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone Alternate Phone #
FAX
E-mail
SPECIAL AUDIO/VISUAL EQUIPMENT
Please check the instructional audio/visual item(s) you will need for your presentation:
 
  Screen   Video Projector (light box, Infocus, LCD projector)
  Podium   Chart Pak and Easel
  Computer   Telephone line for internet connection
  Microphone  
PLEASE INDICATE BELOW YOUR CHOICE OF MICROPHONE EQUIPMENT:
  Podium microphone      Hand held microphone      Lapel microphone

Provide below the type and version of presentation software you use (i.e. Microsoft Word, Powerpoint, etc.)  Please email your presentation to workshops@aptac-us.org three (3) weeks prior to the conference start date.   Our audio/visual team will load your presentation on their equipment and test it prior to your workshop.

  Other equipment needs (please indicate below)

In the space below, provide us with a short bio.  This information will be used to introduce you to the audience.

 
 

TRAVEL INFORMATION

Time/Date of Arrival
Time/Date of Departure



Copyright © 1999 [PHS/APTAC]. All rights reserved.
Revised: 03/04/08