Speaker Proposal
ATMIM is accepting speaker proposals for our 2019 Spring Conference. ALL PROPOSALS must be received electronically by January 7th, 2019.

Theme: Engage, Activate, and Motivate!

Date: 8:00 AM-3:00 PM
Thursday, April 11, 2019

Location: College of the Holy Cross (Worcester, Massachusetts)

Personal Information
Title
First Name *
Your answer
Last Name *
Your answer
Employed by *
(school district, employment affiliation, retired, self-employed, etc.)
Your answer
Home Address (Street) *
Your answer
Home Address (Town) *
Your answer
Home Address (State) *
Your answer
Home Address (Zip Code) *
Your answer
Home Phone *
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Primary Email *
Your answer
Preferred Method of Contact *
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