HECBC Research and Creativity Conference

Presenter's First Name

Presenter's Last Name

Presenter's Email Address

Phone Number

Class Standing

Presenter's Home College/University

Other College/University

Faculty Mentor/Sponsor First Name

Faculty Mentor/Sponsor Last Name

Faculty Mentor/Sponsor Email

Category - Please select the category of your proposal

Presentation Format

Equipment Requests - Hold ctrl and click the options to select more than one

Do you have one or more co-presenters?

Yes

No

Co-Presenter(s) *Co-presenters may register for lunch under the lunch registration.*
Please list first name, last name and email of all co-presenters.

Co-presenter 1 First Name

Co-presenter 1 Last Name

Co-presenter 1 Email

Co-presenter 2 First Name

Co-presenter 2 Last Name

Co-presenter 2 Email

Co-presenter 3 First Name

Co-presenter 3 Last Name

Co-presenter 3 Email

Co-presenter 4 First Name

Co-presenter 4 Last Name

Co-presenter 4 Email

Co-presenter 5 First Name

Co-presenter 5 Last Name

Co-presenter 5 Email

Co-presenter 6 First Name

Co-presenter 6 Last Name

Co-presenter 6 Email

Co-presenter 7 First Name

Co-presenter 7 Last Name

Co-presenter 7 Email

Co-presenter 8 First Name

Co-presenter 8 Last Name

Co-presenter 8 Email

Will you be having lunch on-site at the conference?

Dietary Restrictions - Hold ctrl and click the options to select more than one

Title of Your Research Project/Creative Work

2-3 Sentence Summary of Your Research Project/Creative Work

Description of Your Research Project/Creative Work - 200 word limit

Availability to present

AM only

PM only

AM or PM

**Persons with disabilities, who need accommodations for this event, should notify the Disability Services Office two weeks prior to the event at (610) 683-4108 or email accommodation@kutztown.edu , TDD number: 610-683-4499, in order to discuss accommodations. Every effort will be made to provide reasonable accommodations.**