Form

Conference Proposal Submission Form
Proposal Committee to Review: (check all that apply) *	Women's Studies LGBTQ IRE Subtheme on intersection of Race, Ethnicity, Gender and Sexuality
Presentation coordinator information.

Name:
Self Description or Professional Title:
Campus or Professional Affiliation:
Mailing Address:
City:
State
Zip:
Daytime Phone:
E-mail Address:
May we include your contact information in the presenters list in the conference packet?	Yes No
Would you like to receive a conference brochure by mail?	Yes
Contact information for co-presenter 1, if any:
Name:
Self Description or Professional Title:
Campus or Professional Affiliation:
Mailing Address:
City:
State:
Zip:
Daytime Phone:
E-mail Address:
May we include your contact information in the presenters list in the conference packet?	Yes No
Contact information for co-presenter 2, if any:
Name:
Self Description or Professional Title:
Campus or Professional Affiliation:
Mailing Address:
City:
State:
Zip:
Daytime Phone:
E-mail Address:
May we include your contact information in the presenters list in the conference packet?	Yes No
Contact information for co-presenter 3, if any:
Name:
Self Description or Professional Title:
Campus or Professional Affiliation:
Mailing Address:
City:
State:
Zip:
Daytime Phone:
E-mail Address:
May we include your contact information in the presenters list in the conference packet?	Yes No
Additional Presenters?
If there are more than 3 co-presenters, please use this space to provide the same information as requested above for each additional person.
Proposal
* indicates required fields
Title of panel / workshop / presentation / poster session: *
Briefly describe your presentation. This will be included in the printed program: *
What type of audio visual equipment will be required for your presentation? *	An Overhead Projector A Document Camera A Slide Projector A VCR to Show a Video A DVD Player A Computer and LCD Projector for a PowerPoint presentation. (I will bring my presentation on a CD or flash drive.) An LCD Projector for a PowerPoint presentation. (I will bring my own computer.) None
Sessions will be organized for all day Friday (April 16) and Saturday (April 17). Please list any times which are impossible for you to present:
Session Information
All workshop sessions will be 60 or 75 minutes in length. Please select whether your proposal is for an entire session or should be put with other proposals to make up a session. we particularly encourage panels which represent a diversity of experiences, perspectives, interdisciplinary, or intergenerational approaches to topics.
My proposal is:	for a whole session. to be put with others for a session. for a poster session.
Conference presenters are asked to register and pay the conference registration fee. Would you or your other presenters need:
A reduced fee?	Yes No
A scholarship to be a presenter?	Yes No
Are you interested in moderating a session?	Yes No
Lodging is available in Whitewater at the Baymont Inn and Suites (262) 472-9400, or in Fort Atkinson at the Americas Best Value Inn (920) 563-6444 (8 miles from site).