Date Submitted: 

Presenter(s) Names: 
 

Workshop or Plenary Title:

Primary Contact Email:   

Primary Contact Phone:   Fax:

                              Alt Phone:

Primary Contact Mailing Address:

Street:

City:     State:  Zip Code:

Audio-Visual Requirements: 

Workshop or Plenary Summary (limit 500 words)

Which theme does your workshop fit into?

Reproductive Health and Sexual Rights	Celebrating Sex and Our Sexuality
Reproductive Justice and Building Our Movement	Reproductive Justice and Human Rights
Reproductive Justice for All	Reproductive Technologies and Women of Color

How would you rate your presentation?   G       PG       R        X        XXX

Will you need your presentation translated into English?   Yes        No

If so, from what language? 

Will you need your presentation verbally translated from ASL?   Yes      No

Please describe any other assistance you will need to present your workshop:

Who will be allowed into your workshop?

Open to all	Only allies	Only LGBTQ
Only women of color	Only women	Only over 18
Only people of color	Only men	Only under 25

What is your ethinic identity?  You may check all that apply.

Native American/ Indigenous	African American/ Black	Latina
Asian/ Pacific Islander	Middle Eastern/ Arab American	White/European American
Bi-racial

Are you located in the U.S.?   Yes      No.

What is your approximate age?

Teens	30's	50's	70's
20's	40's	60's	80's

SisterSong will publish written proceedings from this conference. Will you submit a written paper on your workshop topic for consideration before the conference?   Yes      No

Thanks for completing the form.  You will be notified of our decision by March 31, 2007