Address:

Phone number and email address:

Professional Position

Category -
____ Speaker at a local school
____ Speaker on a video conference

Published books (title, date, genre, agent)

Books in print, how to order copies

Title of your presentation

What curriculum related topics will be addressed (science, social studies, history, English, languages, etc.)

Describe what you will do with the students - interactive or not? Do students participate? If so, how.

Describe any handouts or props you will use as part of your presentation.

Equipment needed for presentation
_____ slide projector
_____ computer power point presentation
_____ overhead projector
______ blackboard
______ other (identify)

How many minutes is your presentation? (Please plan for 40 minutes)

Do you prefer:
_____ multi-classroom/assembly -type presentations
______single class sessions
______either

Would you like to be added to our authors' data bank?
_____ Yes
_____ No
_____ Unsure