2014 GCSN Conference Presenter Application
Use this form to apply to present a workshop at the 2014 GCSN Conference for STEM Education. All areas of STEM (science, engineering, technology, and math) are welcome but we are especially looking for workshops for teachers that address the common core standards and Next Generation Science Standards (NGSS). Sessions may also focus on instructional strategies and resources/organizations for STEM education.

Please contact Debbie Bereki at 805-525-2471 or berekid@gmail.com for more information or if you need help with this form. Alternatively, you may download the presenter application from our website at http://www.goldcoastscience.org and mail it via the postal service. However, ALL APPLICATIONS MUST BE RECEIVED BY OCTOBER 15, 2014; though earlier is much appreciated!

COMPENSATION:
One complimentary conference registration will be given to the lead presenter of the workshop, including continental breakfast and lunch. Please submit a registration form with payment for any co-presenters. Presenter applicants will be notified if their workshop is accepted via email. Occasionally we receive too many applications for some grade levels or topics and must turn away a few. Please submit a registration form with payment if your response back indicates that we were not able to accept your application, or for any co-presenters.

HANDOUTS AND WORKSHOP MATERIALS:
Presenters are responsible for furnishing their own handouts and workshop materials. No copy service will be available onsite during the conference.

Thank you for your participation. The work you do is important and the conference would not be possible without generous and dedicated individuals like yourself. Together we can make STEM Education stronger, better, more engaging for our youth!

Name: *
Your answer
Job Title:
Your answer
School or Organization:
Your answer
Grade Level (if applicable):
Your answer
School or Organization Address (street, city, state and zip):
Your answer
Best Phone Number for Contact: *
Your answer
Home Address:
Your answer
E-Mail Address (all conference updates and reminders are sent via email): *
Your answer
All workshops are 55 minutes. Do you prefer a morning or afternoon session? *
Title of Workshop: *
Your answer
Description of Workshop for Program (Maximum 25 words): *
Your answer
State Standards and/or Next Generation Science Standards Addressed: *
Your answer
Target Audience (select all that apply): *
Required
Area of Emphasis (check all that apply): *
Required
Type of Workshop (choose the one that is MOST applicable): *
Equipment Required (select all that apply):
Additional Equipment Needed / Facilities Request:
Your answer
SAFETY: The use of hazardous materials is to be avoided. Are there any potential safety hazards associated with your workshop? *
Required
If you selected "Yes" above, please explain further and identify the precautions that will be taken:
Your answer
TERMS AND CONDITIONS: Please review the terms and conditions below. Please start by confirming that you are available to present your workshop at the conference on Saturday, November 8, 2014. *
Required
I agree to indemnify and hold harmless GCSN for any and all claims, loss, damage, or injury associated with unsafe practices related to my workshop. *
Required
I agree to assume full financial responsibility for costs incurred as a result of unsafe practices related to my workshop. *
Required
I agree not to sell items or collect money for any reason during my workshop. *
Required
I understand that GCSN reserves the right to edit all titles and descriptions of workshops for the program.  *
Required
I am the person whose name is listed at the top of this application. By checking the "Yes" box below, I agree that it will serve as my signature. *
Required
Conference participants are granted a free two-year membership to Gold Coast Science Network (GCSN). GCSN does not sell or share your information with other organizations. Would you like to join GCSN? (Learn more about GCSN at http://www.goldcoastscience.org) *
Required
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