* First Name:

* Last Name:

Middle Initial:

Job Title:

Company/
Organization:

Address:

Address 2:

City:

State/Provence:

Zip/P.C.

Country:

Tel:

Fax:

* Email:

Web Address:

Presentation Title:

Objective:

Target Audience:

100 to 200 word description of your presentation:

Length of presentation and format:
Seminar (50 min.) Workshop (3 hr.)

Have you presented this topic elsewhere? If yes, where and when?

Your qualifications to speak on this topic (Bio):

Names of other potential speakers for your session:

What is your relationship to the topic you are proposing?
User
Vendor
Consultant
Academic

Whaich TRACK do you feel your presentation best fits?
Industrial Automation
Design Engineering
Plant Engineering
Quality Testing
Assembly Technology
Electronics Assembly/SMT