SETA Workshop Suggestion
Only completed forms may be submitted.
Title of Workshop *
Your answer
Workshop Description *
Please provide a 150-200 word description of your workshop that accurately reflects the presentation content. The description should be compelling, free of spelling and grammar errors, and suitable for print in the conference program as submitted:
Your answer
Equipment Needs
A digital projector and screen are automatically provided in the presentation space. Please plan to bring your own laptop along with your presentation. Please identify any additional presentation aids/technology you require which you will not provide:
Topical Area *
Specify the primary topic of this workshop presentation
Required
Primary Presenter Information *
Name:
Your answer
Primary Presenter Information *
Title:
Your answer
Primary Presenter Information *
Company/Organization:
Your answer
Primary Presenter Information *
Street Address:
Your answer
Primary Presenter Information *
City Address:
Your answer
Primary Presenter Information *
State Address:
Your answer
Primary Presenter Information *
Zip Code:
Your answer
Primary Presenter Information *
Phone:
Your answer
Primary Presenter Information
Fax:
Your answer
Primary Presenter Information *
Email:
Your answer
Primary Presenter Information *
Biography (please include a biographical summary of this presenter, not exceeding 200 words):
Your answer
First Additional Presenter Information, if applicable
Name:
Your answer
First Additional Presenter Information
Title:
Your answer
First Additional Presenter Information
Company/Organization
Your answer
First Additional Presenter Information
Street Address:
Your answer
First Additional Presenter Information
City Address:
Your answer
First Additional Presenter Information
State Address:
Your answer
First Additional Presenter Information
Zip Code:
Your answer
First Additional Presenter Information
Phone:
Your answer
First Additional Presenter Information
Fax:
Your answer
First Additional Presenter Information
Email:
Your answer
First Additional Presenter Information
Biography (please include a biographical summary of this presenter, not exceeding 200 words):
Your answer
Second Additional Presenter Information, if applicable
Name:
Your answer
Second Additional Presenter Information
Title:
Your answer
Second Additional Presenter Information
Company/Organization:
Your answer
Second Additional Presenter Information
Street Address:
Your answer
Second Additional Presenter Information
City Address:
Your answer
Second Additional Presenter Information
State Address:
Your answer
Second Additional Presenter Information
Zip Code
Your answer
Second Additional Presenter Information
Phone:
Your answer
Second Additional Presenter Information
Fax:
Your answer
Second Additional Presenter Information
Email:
Your answer
Second Additional Presenter Information
Biography (please include a biographical summary of this presenter, not exceeding 200 words):
Your answer
Third Additional Presenter Information, if applicable
Name:
Your answer
Third Additional Presenter Information
Title:
Your answer
Third Additional Presenter Information
Company/Organization:
Your answer
Third Additional Presenter Information
Street Address:
Your answer
Third Additional Presenter Information
City Address:
Your answer
Third Additional Presenter Information
State Address:
Your answer
Third Additional Presenter Information
Zip Code:
Your answer
Third Additional Presenter Information
Phone:
Your answer
Third Additional Presenter Information
Fax:
Your answer
Third Additional Presenter Information
Email:
Your answer
Third Additional Presenter Information
Biography (please include a biographical summary of this presenter, not exceeding 200 words):
Your answer
Expense Reimbursement Request
SETA is cost conscious in the selection process related to requests for fees, honorariums, and expense reimbursements. The presenter should give careful consideration to those requests, utilizing other financial resources to facilitate participation to the greatest extent possible.
Your answer
Estimated Travel/Airfare *
Enter dollar amount only. Enter 0 if no reimbursement required.
Your answer
Honorarium/Fee Expenses *
Enter dollar amount only. Enter 0 if no reimbursement required.
Your answer
Number of Complimentary Rooms *
Enter a number only. Enter 0 if no reimbursement required.
Your answer
Number of Nights for Each Room (only if requesting complimentary rooms) *
Enter a number only. Enter 0 if no reimbursement required.
Your answer
Estimated Date of Arrival (only if requesting complimentary rooms)
MM
/
DD
/
YYYY
Estimated Date of Departure (only if requesting complimentary rooms)
MM
/
DD
/
YYYY
Complimentary Registration *
Required
Other Estimated Expenses *
Enter dollar amount only. Enter 0 if no reimbursement required.
Your answer
Total Estimated Speaker Expenses *
Enter dollar amount only. Enter 0 if no reimbursement is required.
Your answer
Additional Comments
Please use this area to include additional details and explain expenses.
Your answer
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