First Name*

Last Name*
  Session Title*:
 Session Number*
 

Email Address*:

  1.  INTRO
Please submit a short introduction to be used by the moderator to introduce you as the speaker of your session.
  Name/Position:
  Organization:
  Location:
  Brief statement of relevant experience (less than 100 words):
  Qualifications (license, certifications, designations):
  Education (degree, if attained):
  2.  AUDIOVISUAL REQUIREMENTS
The conference standard meeting room set will include an LCD projector, screen, and one wireless lavaliere microphone. You are required to bring your own laptop if needed for your presentation. Laptops will not be provided. If you are speaking on a panel, (1) wireless lavaliere microphone and table microphones will be provided.
(Please provide A/V that will be required.)
  LCD/Computer Projector - You are required to bring your own laptop.
    My laptop/tablet make and model is:
    List the type(s) of external video output connections available on your laptop/tablet:

Please be sure to bring your charging/data-USB cord.
    Other:
No requests for overhead projectors, flip charts or white boards will be honored due to room size and inability of the audience to see these well.
 

3.  SESSION RECORDING (PERMISSION IS ASSUMED. THE BOX BELOW MUST BE CHECKED AND RECEIVED BY MARCH 14, 2013 TO DENY RECORDING.)
Recorded sessions will be made available for sale to ASSE members and nonmembers at a nominal cost. All speakers are eligible to receive complimentary access to their session. ASSE may, in the future, copy, distribute, play, show, display or otherwise make available the recordings by any means and in any media.
  I hereby deny ASSE permission to record my presentation at the 2013 Professional Development Conference
  4.  PROCEEDINGS PAPER REMINDER
All speakers are expected to contribute a paper for the Conference Proceedings.  The Proceedings will be produced in CD-ROM version only.  Papers are due to ASSE, Jeri Stucka, jstucka@asse.org by March 14, 2013.

  5. PHOTOGRAPH
If you would like your photograph added to your session description on the Safety 2013 website, please up upload your photograph here.  The photo must be a headshot, less than 2 megabytes, jpg or png format, 300 dpi resolution or higher. 

  * Filename:
(jpg or png)
 

Comments / Questions: 
 


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