Title of Presentation:

Contact Information for the primary presenter of the above title:

First Name:
Last Name:
Institution
Department
E-Mail Address
Telephone Number

Whom should our Technology Staff contact at your institution with technical questions about your presentation?

First Name:
Last Name:
Department
E-Mail Address
Telephone Number

AUDIOVISUAL & EQUIPMENT REQUIREMENTS
Please indicate minimal requirements
If you are not requesting equipment, please click here
Computer Equipment
Please note: Computer equipment is limited. We will make every effort the accommodate your requests

Macintosh Computer

IBM Compatible

Other: List any additional computer needs below. Be as specific as you can about model numbers, configuration, and minimal memory requirements. We will contact you to confirm your request.
Please state additional computer needs here.

Peripherals: Click on your choices.

Overhead Transparency Projector	Audiocassette Recorder/Player
35mm Slide Projector	Second Monitor (data, tv, rgb, vga, ega)
VHS VCR	Flip Chart
Laserdisc Player - Specify make and model:

Special Needs
List the special hardware and/or software needed for your presentation. (Reminder: we may not be able to meet all your needs. You may have to bring your own items.)
Please type info here.

List equipment and software you will bring for your presentation.

Please type info here.

You may print out this form and mail it to:
Conference Overview and Announcement CTW Mellon Home	Ms. Pamela Perrone CTW Mellon Project North College 237 High St. Room 303 Wesleyan University Middletown, CT 06459 pperrone@wesleyan.edu (860) 685-4875	Registration Form Presentation Proposal Form