Heartland Christian Schools

Presenter Information
First Name *
Last Name *
School/Organization Name
*
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Work Phone * ### - ### - ####
Home Phone * ### - ### - ####
Cell Phone
### - ### - ####
Email 1
*
Email 2
What is the best way to contact you during the summer?
For the Convention Catalog

We would like to include your e-mail address in the catalog to allow continued networking after the convention. If you have more than one e-mail, please indicate which one you would like listed. If you do NOT want your e-mail included please indicate *Do NOT include.
Preferred e-mail address
Email 1 Email 2 Do NOT include
I am NOT able to present at these times
11:00 a.m. Thursday, October 6 12:00 p.m. Thursday, October 6 1:15 p.m. Thursday, October 6 8:15 a.m. Friday, October 7 9:30 a.m. Friday, October 7
Presenter Position and/or
Title
Please provide some information about yourself to be included in the convention catalog. (i.e. previous position, education, awards, publications, etc).
Maximum Allowed: 60 words. Currently Used: 0 words.

Note that your current position will be listed separately, so there's no need to include it here.
Sectional Information

Be clever and specific! This information will be included in the convention catalog.
Title of Sectional *
Describe your sectional
*
Maximum Allowed: 60 words. Currently Used: 0 words.
Target audience (grade level/s, general)

Indicate the grade level, or range of grade levels, for which your presentation is suited. You may also indicate for general audience.
Willing to present THIS
sectional twice? *
Sure, why not! Not this time, sorry.

It helps the planning committee to know this. We'll confirm with you if we wish to schedule your sectional twice during the convention.
If you have consented to present TWO separate topics please supply info on your second topic :

If presenting ONE topic proceed on to "Money Matters" portion.
Title of Sectional
Describe your sectional
Maximum Allowed: 60 words. Currently Used: 0 words.
Target audience (grade level/s, general)

Indicate the grade level, or range of grade levels, for which your presentation is suited. You may also indicate for general audience.
Willing to present THIS
sectional twice? *
Sure, why not! Not this time, sorry.

It helps the planning committee to know this. We'll confirm with you if we wish to schedule your sectional twice during the convention.
Money Matters

Workshop presenters will receive a $70 honorarium (co-presenters please share the honorarium). Presenters who repeat a session will receive an additional $35. Presenters who are not traveling to the convention with their school will be reimbursed for mileage.
Round trip miles
Handouts

We suggest that you plan for 35 participants in each sectional. If you like, you may have copies made at Dordt's copy center during the convention.
What equipment and type of room will work best?
Equipment Request
Overhead projector Projector for Presenter's Personal Computer TV/DVD player Whiteboard Other
Room Preference *
with desks with table computer lab no preference
Other requests
Thank you

Clicki on SUBMIT to send your information to the convention office.

Heartland Christian Schools
498 4th Avenue NE
Sioux Center, IA 51250

712 722 6216 or toll-free 866 9 CENTER
fax 712 722 6376

csi6@dordt.edu

We look forward to your presentation(s) at this year's convention.
Do Not Fill This Out

Heartland Christian Schools

Presenter Information

For the Convention Catalog

Sectional Information

If you have consented to present TWO separate topics please supply info on your second topic :

Money Matters

Handouts

What equipment and type of room will work best?

Thank you