MAFAA Conference Planning Committee

Online Interest Session Information Form

Please fill out the form. The information will be mailed to the Conference Planning Chairperson.

Conference:	(required)
Name of Session:
Date of Session:	(required)
Time of Session:	(required)
Description of Session: "Final description for Agenda"

Presenter 1 Information
Name:	(required)
Title:
School/Business:
Street Address:
City, State, Zip:
Phone with area code:

Presenter 2 Information (if needed)
Name:
Title:
School/Business:
Street Address:
City, State, Zip:
Phone with area code:

Audio/Visual Needs: (check all that we need to provide)	Overhead Projector LCD Projector Screen VCR Podium Microphone Lapel Microphone Internet Connection

Moderator Information
Name:
Title:
School/Business:
Street Address:
City, State, Zip:
Phone with area code:
Other Arrangements and Details: (fees, lodging, meals, transportation, etc. and who will pay for these?)
Submitted by:
The data from this form will be emailed to the Conference Planning Chairperson. Print out the next page and keep a copy for your records. Enter Security Code: