Workshop Presenter Application

DEADLINE MARCH 2
The Region VI Annual Safety Conference makes available peer taught instructional classes. As a workshop instructor, you will have full access to the conference and all of the events associated with the conference including other workshops, general sessions, award dinners, and more. If your workshop is selected, each member of your workshop will receive a $100.00 discount from the registration fee. Upon approval, you will receive a notice from the registration system stating that your registration has been approved. In that notice will be a link that will take you back to your registration and allow you to pay immediately or invoice yourself. If you submit more than one workshop, be prepared to instruct every workshop that you submit. If you are an exhibitor, you will not be asked to pay an additional fee of any kind unless you are adding a name that is not associated with your exhibitor registration. If you have any questions specific to Workshop Registration, you may submit them to the Workshop Coordinator Johnny Collazo ( collaja@cpchem.com )

First Name (*)

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Last Name (*)

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Job Title (*)

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Company (*)

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Address 1 (*)

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Address 2

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City (*)

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State (*)

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Zip Code (*)

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Phone (*)

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Email Address (*)

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VPPPA Site ID

Invalid Input You MUST enter a VPPPA Region VI Area site ID if you are a member of the VPPPA and intend to vote in the Region VI election process.

Voter Type

Invalid Input If voting.. please select your representation type

Presenter Type (*)

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Proposed Workshop Title (*)

Invalid Input Please do not use "quotes". Keep it as short and simple as possible.

Workshop Summary (*)

Invalid Input Please give a brief summary of your proposed workshop. Keep in mind that your summary description could be used in conference publications as well as on this website. Please check for spelling and grammar inconsistencies.

Session Type (*)

Invalid Input General=The speaker does all the work | Interactive=You try to get your audience involved more than just with simple Q&A | Advanced=You are requiring your audience to have already developed a comprehensive understanding of the topics you are discussing

Session Category (*)

Invalid Input Select the category your workshop best relates to.

Will there be additional speakers besides the name previously entered? (*)



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First Name (Presenter2)

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Last Name (Presenter 2)

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Job Title (Presenter 2)

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Company (Presenter 2)

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Email Address (Presenter 2)

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VPPPA Site ID (Presenter 2)

Invalid Input You MUST enter a VPPPA Region VI Area site ID if you are a member of the VPPPA and intend to vote in the Region VI election process.

Voter Type (Presenter 2)

Invalid Input If voting.. please select your representation type

Presenter Type (Presenter 2)

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First Name (Presenter3)

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Last Name (Presenter 3)

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Job Title (Presenter 3)

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Company (Presenter 3)

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Email Address (Presenter 3)

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VPPPA Site ID (Presenter 3)

Invalid Input You MUST enter a VPPPA Region VI Area site ID if you are a member of the VPPPA and intend to vote in the Region VI election process.

Voter Type (Presenter 3)

Invalid Input If voting.. please select your representation type

Presenter Type (Presenter 3)

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First Name (Presenter4)

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Last Name (Presenter 4)

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Job Title (Presenter 4)

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Company (Presenter 4)

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Email Address (Presenter 4)

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VPPPA Site ID (Presenter 4)

Invalid Input You MUST enter a VPPPA Region VI Area site ID if you are a member of the VPPPA and intend to vote in the Region VI election process.

Voter Type (Presenter 4)

Invalid Input If voting.. please select your representation type

Presenter Type (Presenter 4)

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Will you be using any presentation equipment? (*)

Invalid Input Select all that apply. Though we don't provide presentation equipment, we want to make sure your equipment reservation is in place with the facility.

Are you an Exhibitor? (*)

Invalid Input Your name or a name associated with your workshop MUST match your exhibitor registration to answer 'YES'