Host Application Form

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Name

First

Last

Confirm Email

Phone Number

Education (Certifications, degrees, experiences, undergraduate, etc.)

Time Slot

STEAM ICAC will be held on May 18 from 8 PM – 4 PM, each guest speaker will have a 20-30 minute presentation. What is your preferred time slot? You may list multiple.

What subject will you be presenting on?

Equipment

Please list any equipment you may need other than a microphone and desk.

Agreements

I acknowledge that I am required to fulfill my duties as a STEAM ICAC workshop leader. I understand that my presence at STEAM ICAC is mandatory and may only be exmpted in case of an emergency, which must be proved by documentation.

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I releases and forever discharges STEAM IC Ontario, its owners, directors, officers, employees, agents, assigns, legal representatives, and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims, and demands for or by reason of any injury to person or property.