2006 Diversity Conference

Submit a Proposal

Your topic must relate to the conference topic "Rebuilding Communities." Please complete this form no later than January 20, 2006. This information may be used in the conference program and Web site, if your presentation is selected. Please Note: Each session is one hour in duration.

Program Title:

Program Description (as it will appear in the printed program):

Must be no more than 65 words

Participant Learning Outcomes:

Abstract (250 words):

Equipment Needs (check all that apply)

TV/VCR/DVD	Easel
LCD Projector (PowerPoint)	Overhead
CD/Tape Player	Flipchart
Other:

Will speaker(s) be present for luncheon?

Yes No

Presenter Information

Name

Title

Agency

Address

City

State

Zip

Phone

Fax

E-mail

Biography
(no more than 100 words)

Co-presenter Information (if applicable)

Name

Title

Agency

Address

City

State

Zip

Phone

Fax

E-mail

Additional Co-presenter Information (if applicable)

Name

Title

Agency

Address

City

State

Zip

Phone

Fax

E-mail

Permission to Broadcast

The Cultural Diversity Conference hopes to record some component of the conference activities for broadcast at another date for SUNY Brockport. These plans may include parts of the break-out sessions, including this proposal. Will you permit your image, likeness, and/or presented materials to be used for such a broadcast?