Workshop Proposal Form If you would like to conduct a workshop or show a 3-D video, please fill out this form. Title or subject of your workshop or video as you want it to appear in the printed PROGRAM: _____________________________________________________________ Description, equipment used, techniques, comments: _____________________________________________________________ _____________________________________________________________ Equipment you will need NSA to provide: _____________________________________________________________ _____________________________________________________________ Equipment you plan to bring: (Make and model of any video projectors) _____________________________________________________________ _____________________________________________________________ Distance from the screen needed for your projector: _____________________________________________________________ Size of audience preferred: _____________________________________________________________ Size of room prefered: _____________________________________________________________ Will you do your workshop or presentation: ONE time only _______ or TWO times _______ Indicate days and times you prefer: Friday Morning: _______ afternoon: _______ Saturday Morning: _______ afternoon: _______ Sunday Morning: _______ afternoon: _______ evening: _______ Your name as you want it printed in the PROGRAM: _____________________________________________________________ Your mailing address: _____________________________________________________________ _____________________________________________________________ Your phone at work: _____________________________________________________________ Your phone at home: _____________________________________________________________ FAX #: _____________________________________________________________ E-Mail: _____________________________________________________________ Please mail this form before June 10, 1999. Please mail to: Bill Moll NSA Workshop Coordinator 224 Glenndale Avenue Decatur, GA 30030 Tel: (404) 378-3026 E-Mail: WHMoll@aol.com

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