2013 WORKSHOP SUBMISSION FORM

Name * First Last

Email *

Do you identify as an LGBTQ Woman of Color? *

Yes No Self Identify:

Workshop Theme

Proposed Workshop Title *

Workshop Description *

Short bio/Qualifications *

Maximum Allowed: 150 words. Currently Used: 0 words.

If your proposal is accepted, this text will be listed in the program.

Please indicate if you:

Are traveling from out of town? Are planning to stay in a hotel? Would like an Elements rep to contact you.

Check all that apply.

Wufoo