First Name:

Last Name:

Preferred Address:

City, State, Zip Code:

Name of School System/College/Affiliation:

Home Phone:

Work Phone:

Email:

FAX:

Please check all that apply in each of the following categories.

Primary Role:

Classroom Teacher
University/College Teacher
Supervisor/administrator
Consultant
Specialist
Representative
Other

Primary Audience:

Early Childhood (PreK-2)
Intermediate (3-5)
Middle School (6-8)
High School (9-12)
College
Mathematics Supervisors/Specialists (NEW!)
General Interest

Primary Standards/Principles:

Algebra
Data Analysis and Probability
Geometry
Measurement
Number and Operations
Communication
Connections
Problem Solving
Reasoning and Proof
Representation
Assessment
Curriculum
Equity
Learning
Teaching
Technology

Indicate the session format/length that you prefer (Please check only one format.):

60-Minute Regular Session - Speaker actively engages participants in activities/discussions about mathematical topics
60-Minute Research Insights Session - Speaker emphasizes the connections between research and practice
90-Minute Extended Session - Speaker actively engages participants in activities/discussions about mathematical topics.
90-Minute Workshop - Speaker provides hands-on experiences with materials (limited number of participants).

Session Title:

Brief description of the session (40 words or less):

MCTM offers free registration to the lead speaker for each session. Co-speakers are responsible for their own registration. If there are additional speakers, please add their names.

Co-Speaker's First Name:

Co-speaker's Last Name:

Co-speaker's Preferred Address:

City, State, Zip Code:

Co-Speaker's School System/College/Company:

Home Phone:

Work Phone:

Email:

FAX:

Would you be willing to offer this session twice?

Yes
No

Are you willing to have pictures from your session published on the MCTM website and/or in the MCTM Journal, The Banneker Banner?

Yes
No

One projection screen will be provided in each meeting room. Please indicate if you will need to use the following (Check all that apply):

I will need a standard overhead projector.
I will need a computer projector (Speakers should bring their own laptop computer. Mac users should also bring their VGA adapter plug to connect to the projector cord.).
My session will be hands-on and I will need to use a computer lab (MS Office suite and Internet access will be available. Additional software will NOT be installed and should be demonstrated on the speaker's laptop only.).