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Contact Information
Name
School or Organization
Title
Work PO Box or Street Address
City
State Zip
Phone Daytime Evening
Fax
E-mail
Check here if you are a UNI alum.
Check here if you have special needs, including dietary. We'll call you to discuss how we can best meet your needs.
Check here if you do not want the information above on a participant roster shared with exhibitors.
I am interested in receiving UNI credit. Please send me more information.
Co-Presenter Information
Co-presenter 1
School or Organization
Title
Work PO Box or Street Address
City
State Zip
Phone Daytime Evening
Fax
E-mail
   
   
Co-presenter 2
School or Organization
Title
Work PO Box or Street Address
City
State Zip
Phone Daytime Evening
Fax
E-mail
Maximum of three complimentary presenter registrations per session. Please register additional presenters at the regular conference fee.
AV Requested:
Overhead projector Slide projector
TV/VCR Slide projector carousel
Target audience:
General Preschool Kindergarten
1st Grade 2nd Grade 3rd Grade
Special Education Title 1
Presentation information:
Title of your presentation
Description
Brief two- or three- sentence summary (approx. 50 words) for the brochure
All sessions will be scheduled at two time slots (unless you indicate otherwise).
Please check your scheduling preference: Back-to-back Staggered
Additional comments

Once you click the submit button, your information will be sent to us via this form. You will be contacted in December regarding your acceptance.
 
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