2017 MMEA Clinic Session Information Form

MMEA Conference Program Cover - 2017

January 25-28, 2017

Tan-Tar-A Resort

Clinician Information
Clinician Name*
First Last
Please enter your name exactly as you wish it to appear in MMEA Conference publications.
Address
Street Address City State ZIP Code
Clinician Email*

Enter "NONE" if no email
Home Phone*
Enter "NONE" if no home phone
Cell Phone*
Enter "NONE" if no cell phone
School or Company Affiliation

(If Applicable)
Clinician Title

If Applicable
Clinician Biographical Information*
*Limit to 150 words or less. ***Please enter biographical information exactly as you wish it to appear in MMEA Conference publications. NOTE: MMEA reserves the right to edit biographical information as needed for publication purposes.

Clinic Session Information
Clinic Presentation for (MMEA Area)*
Title of Clinic/Session*

Please enter the TITLE of the session exactly as you wish it to appear in MMEA Conference publications.
Clinic/Session Description*
* Limit description to 80 words or less. **Please enter the description exactly as you wish it to appear in MMEA Conference publications. ***MMEA reserves the right to edit session descriptions as needed to comply with publishing guidelines.
Clinician/Clinic Sponsor/s
Please provide pertinent information regarding any/all sponsorship for this session. (i.e. Name of sponsoring company/organization, contact person, contact person information - email, phone, etc.)
Equipment Needs*
- NONE
- Piano
- Data Projector
- Audio Connection to "house" sound system
- Other (Please indicate needs below)
NOTE: Computer availability is the responsibility of the clinician. MMEA does not provide computers for event sessions.
Additional Equipment Needs

Please list any additional equipment/audio visual needs required for this session.
Does this session require a DEMO Ensembles?*
- YES
- NO
NOTE: Please refer to Section 10.4 of the MMEA Performance Application Criteria for information regarding Demonstration Ensembles.
Additional Information
Please provide any additional information that may be relevant to the success of this presentation.

Clinician Information