Presenter Form – Math Institute

Date*
MM slash DD slash YYYY
Your Name*
First Last
Your Email*
Enter Email Confirm Email
Cell Phone*
Only for use by administrators on the day of the event, in case of emergencies or tech issues
Your ABE Program/Consortium/Site*
OTHER: If not listed above, what is your ABE program?*
Virtual Event Details
Virtual Event Title*
- Math Institute
Virtual Event Date*
MM slash DD slash YYYY
Title of Your Session*
What is your role in the presentation?*
- Lead Presenter/Facilitator
- Co-Presenter/Facilitator
- Panelist
Please provide a brief bio (200 words or less):*
Please provide a description of your session/webinar (approximately 3-5 sentences).*
It is your responsibility as Lead Presenter to inform Gail Rutan directly of any changes after your presenter form has been submitted.
Do you have any co-presenters and/or panelists?*
- Yes, I have co-presenters and/or panelists.
- No; I am presenting alone.
Please list the names and emails of all your co-presenters and/or panelists.*
CLICK PLUS SIGN ON RIGHT TO ADD MORE ROWS. It is your responsibility as Lead Presenter to inform Gail Rutan directly of any additions/deletions/changes after your presenter form has been submitted.
First & Last Name Email Organization Presentation Role (i.e., co-presenter, panelist, table coach, etc.)
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REQUIRED: Please suggest 4 dates/times for a 1-hour TECH RUN-THROUGH of your session during the WEEK OF THE EVENT.
CLICK PLUS SIGN TO ADD MORE TIMES. Gail Rutan will follow up with you on the final date and time.
Day of Week Date Time Frame (e.g., 12:30-3pm)
Will you need to receive a registration list before the event?*
- Yes
- No
By when will you need the registration list?*
Additional Instructions
Additional instructions or questions for Senior Events Manager Gail Rutan:

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Presenter Form – Math Institute

Virtual Event Details

Additional Instructions

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Gail Rutan

First & Last Name	Email	Organization	Presentation Role (i.e., co-presenter, panelist, table coach, etc.)

Day of Week	Date	Time Frame (e.g., 12:30-3pm)