Workshop Submission Form

Pronoun Preference:

Presenter Name:

Email:

Address:

City:

State/Prov.: Please select: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - - - Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Is. Quebec Saskatchewan Yukon Territory

ZIP/PC:

Country:

Phone:

1. Name of co-presenter(s), if applicable:

2. Name of workshop:

3. Objective/Goal:
Examples can include things like "promote a deeper dialogue", "present information and research", "broaden horizons", etc.

4. How will you specifically structure your workshop/presentation to meet these objectives or goals?:

5. Please provide a 150 word or less workshop description for the program book and website*:

6. Please provide a 75 word or less bio for yourself and each co-presenter*:

* We reserve the right to edit for the sake of space and clarity.

7. Have you presented this workshop in the past? If so, where? If not, have you presented other workshops in the past? If so, what types?:

8. How would you describe your target audience? For example, "people of color", "partners", "people with kids", "genderqueer", etc.:

9. What uniquely qualifies you to present this topic? What qualifies you to present this workshop to your target audience (Gender Odyssey does not necessarily measure qualification by degrees obtained. We are more interested in your practical experience.):

To assist us in our workshop evaluation and selection process, please provide us with the following:

Format of session (check all that apply):

• Large/whole group discussion
• Small group discussion
• Roundtable discussion
• Panel presentation
• Research/technical presentation
• Activity
• Mainly Q & A
• Other:

Open/Focused/Closed
We recognize the value of workshops or discussions designed to target a specific audience or create a focused dialogue. Is your session open to all attendees, open to all but focused in content, or closed to all but a specific group?

• Open to all
• Open to all, but content is focused to this particular audience:
• Closed to all but this audience:
  

A/V Needs
We are able to provide the following equipment for your presentation. Please let us know what you need:

• Flip chart and markers
• Projector and screen for PowerPoint presentations (limited availability, early submissions receive preference.)

Gender Spectrum records many of its sessions (audio only) as a means to increase accessibility to information for those unable to attend either a specific session or attend the conference as a whole. By checking the waiver below, you are consenting to this recording.

I consent to have my presentation audio recorded for potential use or broadcast on the Gender Spectrum or Gender Odyssey web site:

YES
NO

I understand that this program may be available on these sites in both live and archived formats. I consent to publication of the program, in whole or in part, without restriction or limitation after broadcast for any educational use. I consent to the use of my name, voice, and biographical material about me in connection with the program publicly and for institutional promotional purposes. I waive the right to inspect or approve any such use of my name, voice, or biographical material. I expressly release Gender Spectrum, Gender Odyssey, its trustees, officers, agents, employees, licensees, and assignees, from any and all claims, including copyright, royalties, privacy, and defamation arising out of any broadcast, exhibition, publication, sale, or promotion of this program.

Please contact us at workshops@genderodyssey.org if you wish to make other arrangements.

1. I understand that the conference staff will notify me by email, no later than June 1, 2009, to let me know whether my proposal has been accepted.
2. If my proposal is accepted, I/we agree to present on the day and time assigned to me/us by Gender Odyssey. I understand that conference programming spans Saturday, Sunday, and Monday (Sept 4 - 6) from 8:00 AM – 5:30 PM.
3. I will register and pay the presenter registration fee (a discounted fee of $90) by July 18, 2009.
4. I understand that Gender Odyssey staff will direct all communications only to the person submitting the proposal and that it is that person’s responsibility to inform any co-presenters of all information and agreements stated herein or in subsequent communications.

Signature:
By typing my name here, I agree to the Presenter Agreement stated above.

Date: