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13th Annual Multi-State Engineering Conference - Speaker Information Sheet
Please return the completed form no later than THURSDAY, MARCH 31, 2016 to:
Brenda Gajan, Executive Director LES, 9643 Brookline Ave, Suite 116, Baton Rouge, LA 70809
Phone (225) 924-2021, Fax (225) 924-2049, Email:
les@les-state.org
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* Indicates required question
Name
*
Your answer
Please check those that apply (if any).
P.E.
PhD.
E.I.
Organization
*
Your answer
Address
*
Your answer
Phone Number
*
Your answer
Email Address
*
Your answer
Number of 50-Minute Sessions
*
**If you are giving two sessions on different topics, please fill out another form providing us with the 2nd Session Title & Abstract**
One Session
Two Sessions
Do you have a preferred Date/Time you would like to present?
If you do not have a preference, please leave this portion blank.
Choose
Sunday, June 5 - AM Session
Sunday, June 5 - PM Session
Monday, June 6
Tuesday, June 7
Title of Presentation
*
Your answer
Abstract (to be used in program):
*
Your answer
Brief Intro Bio (250 words or less; to be used in program)
*
Your answer
PLEASE NOTE: Speakers are required to provide their own Laptop and LCD projector
*
By typing your name below, you acknowledge that you are responsible for providing the above mentioned equipment for your presentation.
Your answer
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