2016 MLA Conference Program Proposal Form

Question Title

* Your Contact Information

Name *

Library *

City/Town

Email Address *

Phone Number *

Question Title

* Are you also the Program Planner?

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* Conference Committee Shepherd (if known) Click here for the 2016 Committee List

Name

Library

Email Address

Phone Number

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* Conference Committee Liaison (if you do not have one, your program will be assigned one)

Name

Library

Email Address

Phone Number

Question Title

* Sponsoring Section or Committee (select one)

PLEASE NOTE: When completing this form, enter all information as it would be indicated on printed materials. Use formal names and titles for speakers and include professional designations if applicable.

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* Proposed Program Title

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* Proposed Program Description (Please be descriptive but concise)

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* Proposed format if known (select one)

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* Proposed Program Audience

Paralibrarian

Youth Services

Technical Services and Technology

Small libraries

Large libraries

Reference & User Services

Other (please specify)

Question Title

* Proposed Speaker 1

Name

Title

Library Name and City or Company Name

Question Title

* Proposed Speaker 2

Name

Title

Library Name and City or Company Name

Question Title

* Proposed Speaker 3

Name

Title

Library Name and City or Company Name

Question Title

* Proposed Speaker 4

Name

Title

Library Name and City or Company Name

Question Title

* Proposed Speaker 5

Name

Title

Library Name and City or Company Name

Question Title

* Requested Budget

Honorarium

Travel

Other

TOTAL

PLEASE NOTE: Employees of MA libraries are not eligible to receive honorariums or reimbursements for travel expenses. All other speakers may request payment (up to $300 standalone presenters; up to $100 panelist) however, encourage presenters to volunteer their time. Speakers will receive 1-day complimentary conference registration for the date of the presentation only; meals will not be covered.

DO NOT contact speakers until your program is approved. Contact Michelle Filleul at filleul@noblenet.org with any questions.

You are encouraged to print a copy of your form before clicking on the 'Done' button below.