Name:

Address: City:

State: Zip:

Phone: Email:

Presenter's School Information:
Name and address of main presenter's school

School:

School Address: City:

State: Zip:

School Phone: Fax:

Name, affiliation and city of all presenters as they are to appear in the program.
(NOTE: We do not have room for job titles, department names, etc., unless it is in lieu of an institution., e.g. Independent Consultant.)

1: 2: 3:

Select ONE for each category:

Type of Presentation:

Lecture
Demonstration
Panel/Discussion
Hands-On

Grade Level:

K-4
5-8
9-10
11-12
College
Other

Grade Level:

Biology
Chemistry
Physics
Earth Science
Physical Science
STS
Environmental
Safety
Research
Inquiry
Pedagogy
Other

PSTA will provide a screen in each room.  Transparency projectors will be provided upon request.  PSTA will NOT provide any LCD projectors; projectors that connect via a computer interface, or internet access. Presenters are responsible for all other equipment at their own expense.  Presenters may bring their own equipment for use at the Hershey Lodge and Convention Center.


Preferred Time Allocation: 
(Please indicate either a morning or afternoon preference.  Provide any notes necessary.)
Morning Session
Afternoon Session




Preferred Day:

Thursday
Friday
No Preference

All rooms are set up in classroom style including tables and chairs.
           
Special Circumstances:  

Need more than 15 minutes setup time
Other, Explain

Other Note to program staff:



Safety Information:
1.  Identify any potential safety hazards associated with your presentation.
2.  What precautions will be taken during the presentation to deal with the hazards and to inform the audience of these hazards?
3.  What safety equipment will be required?  Please indicate provider.



Deadline: Proposals must be received on or before May 30 to procure room arrangements and AV needs. Confirmations will be sent by late summer.  Late proposals cannot be given special consideration as to time preference.

For questions contact:
Dr. Christine Royce
PSTA Program
PO Box 305
Newburg, PA 17240
717-477-1681
717-477-4046 fax
CARoyce@aol.com

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