2005 SPEAKERS FORM

The South Carolina Middle/Elementary School Academy of Science Workshop

Saturday, October 8, 2005

South Carolina State University

Orangeburg, SC

PLEASE COMPLETE AND FAX TO DON JORDAN AS SOON AS POSSIBLE

Primary Presenter:

1.             Name  __________________________________________________

                Dept.  __________________________________________________

                School/Inst./Co.  __________________________________________

                Work Address  ___________________________________________

                City, State, Zip  ___________________________________________

                Work Phone  (         )  _______________________________________

                Home Address  ___________________________________________

                City, State, Zip  ___________________________________________

                Home Phone  (        ) ________________________________________

                Email        ________________________________________________

p            List any additional presenters on the reverse side (attach extra paper if necessary).

                Presiders for each session will be student members of the South Carolina Academy of Science

I.          Type of Session

p            Hands-On Activity with Students (50 min.)

p            Demonstration (50 min.)

p            Other

II.        Intended Audience

p            Elementary Grades 4 & 5

p            Middle Level Grades 6, 7, & 8

p            Both Elementary and Middle Grades 4 - 8

p            General (Teacher, Parents, & Students)

p            Teachers Only

p            Parents Only

Note:  Parents can attend any session with their children.

III.       How Many participants can you accommodate at your session?

                p            15 - 20                     p            30 - 35

                p            20 - 25                     p            35 - 40

                p            25 - 30                     p            Over 40

IV.       Equipment Required

                p            Screen

                p            Overhead Projector

                p            Slide Projector

                p            Other(s) - Please Specify  ______________________________________________

There are a few rooms with tables in lieu of traditional desk for students.  If you will need tables please indicate so here _____________________________________________________________.

Please note presenters are requested to bring their own equipment if possible.

VI. Title of Presentation:  __________________________________________________________

__________________________________________________________________________________

Brief Description (Limit to 25 words)  ______________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

VII. Your Hometown Newspaper  __________________________________________________

___________________________________________________________________________________

VIII.    Brief Description of you for News Release:

__________________________________________________________________________________

__________________________________________________________________________________

___________________________________________________________________________________

____________________________________________________________________________________

___________________________________________________________________________________

Note: Usually each presenter does two identical presentations -

one at approx. 10:10 a.m. and one at approx. 11:20 a.m.

RETURN THIS FORM ASAP By Friday, July 22, 2005 TO:

Don Jordan ß Center for Sci Ed / CAS / 323 Sumwalt ß USC ß Columbia SC ß 29208

FAX:  (803) 777-4396           Email: jordan@gwm.sc.edu  FOR QUESTIONS, CALL (803) 777 – 7007 Or 777-8759

You can Fax, or email this information too.