1. 2011 Eastern Sierra Child Development Conference
Application to Present
Proposals may be submitted via e-mail if formatted in Word. Send to Kathy.love@navy.mil or
tfrench@ssusd.org
TYPE OR PRINT CLEARLY – All information must be completed
Name_________________________________________________________________
This person will be the contact for the presentation
Affiliation_____________________________________________________________
Professional Title_______________________________________________________
Address ______________________________________________________________
City ________________________________ State ___________ Zip______________
Phone: Work ________________________ Home_____________________________
Fax ________________________________ E-mail____________________________
Co-Presenter (if applicable)
Name ________________________________________________________________
Affiliation_____________________________________________________________
Professional Title ______________________________________________________
Address ______________________________________________________________
City __________________________________ State ___________ Zip____________
Phone: Work __________________________ Home __________________________
Fax __________________________________ E-mail__________________________
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Workshop Title ________________________________________________________

2. Workshop Description (for brochure – 30 word limit). Include major goals; be as accurate as
possible using specific, clear, concise, and action language to help registrants select appropriate
workshop. Please specify target audience (i.e. Infant/Toddler Providers, Family Child Care Providers,
Administrators, Classroom Teachers, Any, etc.)
Workshop Format (check all that apply)
_____ Discussion
_____ Small Group Activity
_____ Audiovisual
_____ Interactive
_____ Other (please specify) __________________________________________
Workshop Session(s) Preferred
The Committee will make every effort to accommodate each presenter’s requested workshop
session(s). However, depending upon the requests, some presenters may be assigned to sessions
other than requested. Please note: Based upon past experiences it has been found that 2-part
and 3-part workshops are not as successful as desired.
_____ Session 1 – (10:30 a.m. to 11:45 a.m.)
_____ Session 2 – (1:45 pm to 3:00 p.m.)
_____ Session 3 – (3:15 p.m. to 4:30 p.m.)
_____ Any of the above
I am willing to present up to one session only  two sessions  all three sessions 
Maximum Class Size Per Session (minimum of 25 participants) ______________________
Room Set Up
All rooms will be set up “theater style” unless otherwise specified by the presenter. The Committee
will make every effort to accommodate each set up request, however, presenters should allow
adequate time if special arrangements are requested.
Set Up selections
_____ Theater style (chairs in rows)
_____ Classroom style (table and chairs)
_____ Open (chairs at edges of room with open space for movement, dance, etc)
Audio Visual Equipment (limited availability) Powerpoint equipment must be provided by presenter.
_____ TV / VCR Unit
_____ TV / DVD Unit
_____ Overhead Projector
Please Note:
Handouts and copies are the responsibility of the presenter
Lunch for each presenter is complimentary (limit two presenters per workshop)
$50 stipend provided to each presenter (limit two presenters per workshop)
Please return form no later than June 3, 2011 to:
Eastern Sierra AEYC
c/o Tina French
P.O. Box 1293
Ridgecrest, CA 93556
e-mail – tfrench@ssusd.org or kathy.love@navy.mil