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.)
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)