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Queer Sexuality and Gender Conference 2012: Workshop Proposal

Page One

1. Contact Information

First Name *This question is required.

Last Name

Pronoun(s)

Title

Company Name

Street Address

Apt/Suite/Office

City

State *This question is required.

Postal Code

Country

Email Address *This question is required.

Phone Number *This question is required.

Fax Number

Mobile Phone

URL

Organizational Affiliation

2. Preferred Name

3. Are there other people with whom you are planning to facilitate this workshop? If so, please list their name(s) and email address(es):
*This question is required.

4. Title of workshop: *This question is required.

5. Brief description of workshop (This will be included in the program): *This question is required.

6. Detailed description of workshop (This is specifically for the conference organizers, not for published conference materials): *This question is required.

7. Presenter bios & preferred pronouns (two or three sentences per person). Please add a blank line between paragraphs for clarity. *This question is required.

8. What supplies are needed for this workshop? *This question is required.

Space Cell	Yes	No
Poster Paper
8x11 Paper
Pencils
Markers
Whiteboard Markers/Chalk
Safer Sex Supplies (please specify)
Projector/Adapter (for laptops to screens)
Other (please specify)

9. If you selected "safer sex supplies" or "other," please specify what supplies you require:

10. Do you have any time limitations to run this workshop?

11. How many times would you like to run the workshop during the conference? *This question is required.

12. How many participants can this workshop accommodate? *This question is required.

13. Is there anything else you think we should know?

If you require accommodations, please contact us at queerconf@hampshire.edu.