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Workshop Leader Form

Expanding Your Horizons
1301 East Main Street
Middle Tennessee state University
Post Office Box X161
Attn: Dr. Judith Iriarte-Gross
Murfreesboro, TN 37132

Phone: (615) 904-8253
Email: eyh@mtsu.edu

MTSU Expanding Your Horizons
In Science and Mathematics Conference 

Name of Leader
Name of Co-Leader 
Name of Co-Leader 
The following contact information is for the primary workshop leader
Street Address:
City:
State:
Zip Code:
Phone:
Fax:
Email:
I will be able to present: One Workshop    Two Workshops    Three Workshops
Name of Workshop:
Which group would you like to present a workshop for: Middle School
High School
Please select the middle school workshop time slots that are convenient for you: 10:00 A.M. - 11:00 A.M.
12:00 P.M. - 1:00 P.M
1:15 P.M. - 2:15 P.M
Please select the high school workshop time slots that are convenient for you: 12:00 P.M. - 1:00 P.M
1:15 P.M. - 2:15 P.M
What type of room do you prefer: Laboratory
Tables
Computer Lab
What type of equipment do you need: Computers
Internet Connection
Would you like to join us for lunch: Yes
No
Leader T-Shirt Size:
Co-Leader T-Shirt Size:
Co-Leader T-Shirt Size:
Please provide a 3-5 sentence summary of your workshop so that we can showcase you on our website. (Include title, summary of topic, and summary of hands-on activity).