Laugh Fest in the Midwest Presenter Registration

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Presenter Information & Registration

Glad to have you on board for our Laugh Fest in the Midwest Conference on Laughter. Please take a moment to fill out relative information for presenters so that we may promote you to best.

Presenter Information

Name:

Email Address:

Contact Phone Number:

Name of Your Organization:

Your Title:

Related Website

Address:

City:

State:

Zip Code:

Add a Brief Biography (50 words or less)

Prior Presentation Experiences: Yes
No

If Yes, please Indicate 3 Major Presentations

Your Presentation Information

Description or your presentation in 100 words or less

Type of Presentation: Lecture:
Interactive Participation:
Combination:

(If Combination please let us know % in each category )

List three Learning Objectives participants will take away from your presentation:

Laughing/Learning Objective #1

Laughing/Learning Objective #2

Laughing/Learning Objective #3

Which professional group will most benefit from your presentation?

If you chose "Other" Please explain.

Equipment/materials/space/room set-up needed: Note: Presenters will be required to provide a ready made disk for PowerPoint if using this as a medium - we will have a laptop/projector/screen available

List your Preferred Presentation Time... we will make the best accomodations on day and time for you (first come first serve) Saturday Morning
Saturday Afternoon
Sunday Morning
Sunday Afternoon

Please supply a current photo image with a resolution of 300 dpi.

Glad to have you on board for our Laugh Fest in the Midwest Conference on Laughter. Please take a moment to fill out relative information for presenters so that we may promote you to best.
Presenter Information
Name:
Email Address:
Contact Phone Number:
Name of Your Organization:
Your Title:
Related Website
Address:
City:
State:
Zip Code:
Add a Brief Biography (50 words or less)
Prior Presentation Experiences:	Yes No
If Yes, please Indicate 3 Major Presentations
Your Presentation Information
Description or your presentation in 100 words or less
Type of Presentation:	Lecture: Interactive Participation: Combination:
(If Combination please let us know % in each category )
List three Learning Objectives participants will take away from your presentation:
Laughing/Learning Objective #1
Laughing/Learning Objective #2
Laughing/Learning Objective #3
Which professional group will most benefit from your presentation?
If you chose "Other" Please explain.
Equipment/materials/space/room set-up needed: Note: Presenters will be required to provide a ready made disk for PowerPoint if using this as a medium - we will have a laptop/projector/screen available
List your Preferred Presentation Time... we will make the best accomodations on day and time for you (first come first serve)	Saturday Morning Saturday Afternoon Sunday Morning Sunday Afternoon
Please supply a current photo image with a resolution of 300 dpi.