MATSA

INVITATION TO SUBMIT
Due by September 15, 2001

PLEASE COMPLETE THIS SUBMISSION FORM:
(Note: all information (required for CEU application) MUST be completed for consideration) ·

• For each presenter: (attach additional pages for multiple presenters)

Name, Degree and year of degree, exactly as it would appear in the brochure: __________________________________________________________________________

Title: _______________________________________

Affiliation: ___________________________________

Address: ____________________________________

Phone: ______________________________________

Fax: ________________________________________

Email:_______________________________________

•Designated contact person:

•Length and type of workshop desired:
_______ pre-conference 1/2 day (180 minutes) (4/10/2002)
_______ 90-minute conference workshop (4/11/2002)
_______ 180-minute conference workshop (4/11/2002)

•Workshop designed to address:
_______ adults _______ adolescents
_______ latency age _______ combined groups (please explain) _________________________
_______________________________________________________________________________

•Level of workshop:
_______ Beginner _______ Intermediate _______ Advanced

•Track:
_______ Practice _______ Research

•Title of workshop:
•Brief description of workshop as it would appear in the brochure (the conference committee reserves the right to edit all descriptions):
•3 learning objectives:

•3 book references:

On separate pages, please submit:
• a one-page abstract of workshop
• curriculum vitae for each presenter
• one paragraph bio on each presenter
• experience as conference presenter
• 2 references (include telephone numbers)

RESPONDENTS ARE ENCOURAGED TO SUBMIT PROPOSALS USING BOTH A HARD COPY AND A 3.5" FLOPPY DISK FORMATTED IN MICROSOFT WORD (please copy the form exactly).

A HARD COPY MUST BE SUBMITTED.

Send completed submission by September 15, 2001 to:

Dr. Steven M. Bengis
MASOC
70 North Summer Street
Holyoke, MA 01040