Minnesota Council of Teachers of Mathematics
2012 Spring Speaker Proposal Form
Please submit this form by December 22nd. If you have any questions, please contact Nikki Bjerke by email at
NikkiBjerke@gmail.com
or by phone at 763-350-1535.
Personal Information
(*Information will be used in conference materials. Email addresses will also be published in the program.)
Lead Presenter Name:
Title:
Address:
City / State / Zip:
Home Phone:
Work Phone:
Email:
Affiliation:
Affiliation City:
I would like to request a presider for my session
I will serve as my own presider for my session
Are there additional speakers for your session?
No Additional Speaker
Yes, there is an additional speaker(s)
Additional Speaker Name:
Affiliation:
Affiliation City:
Additional Speaker Name:
Affiliation:
Affiliation City:
Session Information
Please check the KEY grade band for your presentation (choose only one):
PreK-2
3-5
6-8
9-12
College
General Interest
Please check any additional APPLICABLE grade levels for your presentation:
PreK-2
3-5
6-8
9-12
College
General Interest
Appropriate strand for your presentation (if applicable):
Frameworks
Equity
Assessments
Standards
Technology
Appropriate length for your presentation:
Regular Session (60 minutes)
Workshop (90 minutes)
Check category, if appropriate:
Exhibitor Session
Publisher Session
Equipment or facilities needs
All rooms will be equipped with a screen ONLY. PLEASE NOTE: Due to limited availability, equipment will be assigned on a FIRST COME basis.
Overhead Projector
Data Projector
Second Overhead Projector
Second Screen
Calculators - Model TI
None
If you are presenting a technology session, please choose the most appropriate category for your presentation:
Beginner Session
Intermediate Session
Advanced Session
Please be as specific as possible in your session description for your intended audience.
Session Title:
(Two lines maximum; 33 spaces per line maximum)
Additional Description for Program:
(Please limit to 20 words)
Special Accomodations
No Special Accomodations Needed
Special Accomodations Needed
Accomodations Needed:
Proposals should be received no later than
DECEMBER 22
to be considered in this year’s program.
If proposal is received prior to December 22nd, the lead speaker will be entered in a drawing for one night’s lodging in a Duluth hotel.
If you have any questions, please contact Nikki Bjerke, Conference Connections: Phone (763) 350-1535 or email NikkiBjerke@gmail.com.