2012 UPECC Workshop Presenter Planner

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The UPECC is requesting approval for CEUs, SB-CEUs, and SW-CEUs for the upcoming conference. It is imperative that all information requested be provided. Please make sure to complete all sections and to send the necessary supplemental information. INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED. All applications and materials must be received on or before December 16, 2011.

Supplemental materials can be:
emailed to: upearlychildhoodconference@yahoo.com,
Faxed to 1-888-906-7488 ATTN:Corey,
or mailed to: UPECC c/o AMCAB ATTN: Corey Holcomb,1125 Commerce Dr., Marquette, MI 49855.

Presenter Information

Please enter the following information about the primary presenter.

Presenter Name *

Please enter your full name

Title *

Please enter your professional title

Agency/Business/Organization *

Mailing Address *

Please enter your full mailing address

Phone Number *

Please enter your preferred telephone number

Fax Number *

Please enter a Fax Number where you can be reached

Email Address *

Please enter a valid email address for confirmation and other pertinent correspondence

Highest Level of Education Completed *

High School

Some College

Associate Degree

Bachelor's Degree

Master's Degree

Doctorate

Other:

Required

Major(s) *

Other Relevant Credentials

Brief Biography and Resume/CV *

Please enter the method by which you are submitting these documents

Do you have a Co-Presenter? *

Yes

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