Please note* = required field

Presenter

*Full Name (first, then last):

 

*Department:

 

*Campus (e.g. Tuscarawas, Stark, Kent):

 

*Choose which one describes your affiliation with Kent State:

Faculty    

Staff    

Emerti    

Alumni    

Graduate Student    

*E-mail:

 

Phone:

 

Co-presenter (if applicable)

First and last name:

 

Their affiliation with Kent State:

Faculty    

Staff    

Emerti    

Alumni    

Graduate Student    

No Affiliation    

Their full department name:

 

Second Co-presenter (if applicable)

First and last name:

 

Their affiliation with Kent State:

Faclty    

Staff    

Emerti    

Alumni    

Graduate Student    

No Affiliation    

Their full department name:

 

If there are additional co-presenters, please enter their full names (first and last), their affiliation with the university, as well as their full department name in the comments section below.

Presentation details

*Title of the presentation:

 

*Name of the meeting at which the presentation was given:

 

*City and state where the meeting took place:

 

*Country where the meeting took place:

 

*Date of presentation (e.g. Feb. 20-25, 2010):

 

Additional information

Enter a summary for possible inclusion in eInside:

 

Please enter any relevant Web links for possible inclusion in eInside:

 

Additional comments: