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					Vendor Session Form

                                                                                                                                                         earth . . . physica
“Science on a Shoestring”

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2010 MSTA 57th Annual Conference – March 4-6, 2010

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Radisson Hotel and Lansing Center – Lansing, Michigan                                                                                                                      . li

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DUE DATE - OCTOBER 5, 2009 – Please print clearly or type, using one form per proposed

session or go to and submit your proposal on-line. Proposals must be received by

Monday, October 5, 2009 to be eligible for complimentary conference registration. Return completed form


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by October 5, 2009, to: MSTA Office - 3300 Washtenaw Avenue, Suite 220, Ann Arbor, Michigan 48104,                                 d              le s
Telephone: (734) 973-0433, Fax: (734) 677-3287.                                                                                                              l...h
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                                                                                                                                                                                              l . . . grants . . . workshops . . .


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Primary Presenter:                                                 Room Requirements:

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(complimentary registration; must be current member of MSTA.)      Our ability to provide any of the items listed

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                                                                   below is limited. If your presentation requires

__________________________________________________                 any of these items, we will do our best to meet
Name                                                               your needs. Please indicate.
                                                                   ❑	 My session needs more than 15 minutes set-up time.
                                                                      Please indicate how much set-up time is needed: _______.
__________________________________________________                 ❑	 Water used for experiments
Company/Organization                                               ❑	 Lecture style set-up (All Chairs)
                                                                   ❑	 Table/Lab style set-up
Preferred Address: ❑ Home ❑ School:                                ❑	 Other (specify): ___________________________
(where you would like to receive MSTA mailings)

_________________________________________________                  Room Size:
Street Address
                                                                   How many participants do you expect at your session?
                                                                   ❑ small (30 or less) ❑ medium (30-100) ❑ large (100 or more)
                                                                   Note: When you get your room assignment, please make sure you
City, State, Zip
                                                                   have enough handout(s).

Work Phone       Home Phone        FAX Phone                       Type of Presentation:
                                                                   ❑	 Regular (45 minutes)         ❑	 Workshop (105 minutes)
__________________________________________________                 ❑	 Exhibitor/commercial (45 minutes: a session that
E-mail*                                                               promotes a particular product in which the presenter has a
*You must provide an e-mail address. All confirmations and            financial interest) Must also be registered as an exhibitor for
communications will be done via e-mail.
                                                                      the conference.
Please list presenter on an attached sheet of paper. Please
provide mailing address for secondary presenter.
                                                                   Which day would you like to present?
Primary Area: (Please choose one or two.)                          ❑ Either day                ❑ Both days
                                                                   ❑ MuST BE Friday, March 5th ❑ MuST BE Saturday, March 6th
❑	 Assessment/Curriculum          ❑	 Biology
❑	 Chemistry                      ❑	 Computers/Technology
❑	 Earth Science                  ❑	 Environmental Education
❑	 General Science                ❑	 Instruction/Pedagogy          Audiovisual Equipment:
❑	 Literacy                       ❑	 Physics
                                                                   Please indicate your needs. If NOTHING is marked, you
                                                                   may be put in a room with no A/V. If you wish to have A/V,
Audience Level: (Check all that apply.)                            please indicate below. Due to our increase in costs, we must
                                                                   apply the charges indicated. To accommodate your A/V fees,
❑	 Early Elementary               ❑	 Late Elementary               we may need to put you in a larger than requested room.
❑	 Middle Level                   ❑	 High School                   ❑	 Overhead Projector and screen (no fee)
❑	 College                                                         ❑	 Screen ONLY (no fee)
                                                                   ❑	 LCD projector and screen ($425 per session)
                                                                   ❑	 35mm slide projector and screen ($75 per session)
                                                                   ❑	 VCR and monitor ($110 per session)
                                                                   ❑	 DVD player and monitor ($110 per session)
                                                                   ❑	 Internet connection ($150 per session)

                                                      Form continued on back
Fee:                                                               Payment Information:
MSTA policy allows presenters to charge a nominal fee to           Payment must accompany this form. (No purchase orders
defray the cost of materials. No fees may be charged for profit,   accepted). As a vendor for MSTA, dues are optional and not
honoraria, or duplication of handouts. Presenters must collect     required to present. Registration for the primary presenter is
these fees on-site. If you need to charge a fee, please indicate   complimentary. If your co-presenter is not employed by your
amount per person $ __________ .                                   company, they are required to be current member of MSTA.
                                                                   Each session submitted is limited to one co-presenter who
                                                                   will receive complimentary registration. Each additional co-
                                                                   presenter needs to pay a registration fee.
Session Information:
(Be creative! Give your session a "catchy" title.)
                                                                   Note: You may deduct $5.00 from the Membership fees if you
Title of Session (10 words maximum):                               choose NOT to receive Journals via the mail. You will receive
__________________________________________________                 an e-mail notification when Journals and Newsletters are
                                                                   available on-line.
Are you also presenting a different session?
Please name:_______________________________________                number ___ x $45 Regular Dues =                        $ ______
                                                                   number ___ x $35 Dues with no printed
Do you have any other meeting commitments?                                          publications =                          0.00
                                                                                                                          $ ______
i.e. MABT, Chemistry Teachers meeting, luncheon, Key
Leaders in Science, etc.                                           number ___ x $30 Student Dues =                        $ ______
                                                                   number ___ x $20 Student Dues with no printed
Please name:_______________________________________                                 publications =                        $ ______
Description of Session: (30 words maximum)                         number ___ x $25 Retired Dues                          $ ______
Please use complete sentences; this will be used in the            number ___ x $15 Retired Dues with no printed
conference program booklet. Please indicate whether this is a                       publications =                        $ ______
hands-on activity or not and if handouts will be provided.         number ___ x $20 Retired co-presenter one day
__________________________________________________                                  registration fee =                    $ ______
                                                                   number ___ x $35 Retired co-presenter two day
                                                                                    registration fee =                    $ ______
__________________________________________________                 number ___ x $20 Co-presenter one day
                                                                                    registration fee =                    $ ______
Detailed Description of Session:
This information will be used by the conference committee          number ___ x $35 Co-presenter two day
to evaluate each proposed session for inclusion in the                              registration fee =                    $ ______
conference. Attach an additional sheet if necessary.               Grand Total:                                              0.00

__________________________________________________                 Payment
                                                                   ❑ Check (check #: _______ ) ❑ Visa ❑ MasterCard
__________________________________________________                 __________________________________________________
                                                                   Credit Card Number
If applicable, please list any state content expectations
and standards your session addresses:                              __________________________________________________
                                                                   Expiration Date        CVV code (3 digit number on back of card)
                                                                   Billing Information
SB-CEU’s:                                                          Address for credit card as it appears on billing statement:
                                                                   (This MUST be an exact match to be processed correctly).
Many Sessions will be selected to offer SB-CEu’s to
attendees. If your session is selected, would you or your
assistant, be willing to sign in and sign out attendees SB-CEu     Name as it appears on credit card (please print)
forms? ❑ Yes ❑ No                                                  __________________________________________________
                                                                   Billing Street Address
Safety Guidelines:                                                 __________________________________________________
                                                                   Billing City                                 State Zip
SAFETY GUIDELINES must be sent at the same time
speaker session form is submitted. No proposal will                __________________________________________________
                    be considered unless the Minimum               Signature
                       Safety Guidelines are sent with
                         form. Proposals must be
                           received by Monday,                       Proposals must be received by Friday, October 5, 2009
                                earth . . . physica

                              October 5, 2009.                       to be eligible for complimentary conference registration.

                                                                     Return completed form by October 5, 2009, to:
                                                                     MSTA Office - 3300 Washtenaw Avenue, Suite 220,

                                                                     Ann Arbor, Michigan 48104, Telephone: (734) 973-0433,
               . physica

                                                                     Fax: (734) 677-3287.
              l . . . life .


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                     You MUST return even if you are only doing a speaking session.
                If not returned, your information may not appear in the on-site brochure.

                                 MSTA MINIMUM SAFETY GUIDELINES
                             FOR PRESENTERS AND WORKSHOP LEADERS


          The Michigan Science Teachers Association, an organization of science education professionals
dedicated to the stimulation, improvement, and coordination of science teaching and learning, supports
scientific safety at all levels. Presenters, workshop leaders, contestants, and authors at MSTA-sponsored
activities serve as roll models for other science educators. As role models, these individuals must develop,
encourage, and display good safety habits at all times. A good safety role model promotes positive safety in
actions, words, behavior, and deeds. Science safety is an integral part of science education and serves as a
preparation for life. Accordingly, MSTA encourages teachers to offer meaningful and safe science
experiences both inside and outside the classroom. MSTA requires that all presentations, workshops, and
related science-education activities, be conducted in accordance with recognized safety procedures and
good common sense. The intent of the safety guidelines that follow is to promote safe science practices at
all MSTA-sponsored activities.

                           ALL PRESENTERS AND WORKSHOP LEADERS


1. Parts of the body are not to be placed in danger, such as placing dry ice in the mouth or dipping hands
   into liquid nitrogen or molten lead. Demonstrations such as the following shall not be conducted:
   walking on broken glass or hot coals of fire with bare feet, passing an electric current through the
   body, and lying on a bed of nails and having a concrete block broken over the chest.

2. Live vertebrate animals may not be used in demonstrations or for experimental purposes. Such
   animals may be used for observation purposes, provided the animals have been lawfully
   acquired, are housed in proper containers, and are handled in a humane way following the NSTA’s
   “Guidelines for Responsible Use of Animals in the Classroom” (NSTA Position Statement).

3. Animals used for experimentation are to be kept in cages at all times except when being used for
   demonstrations. The Radisson Hotel reserves the right to limit housekeeping services in these rooms.

4. Live ammunition, firearms, or acutely dangerous explosives, such as benzoyl peroxide, diethyl ether,
   perchloric acid, and sodium azide, may not be used. Commercially available firecrackers and blasting
   caps shall never be employed.

5. Plants with poisonous oils (e.g., poison ivy), saps (e.g., oleander) or other plants known to be generally
   toxic to humans are not to be used. (Resource: Human Poisoning from Native and Cultivated Plants,
   by James W. Hardin and Jay M. Arena. The publisher is Duke University Press, Durham, NC 27708).

6. Experiments or demonstrations with human blood/body fluid may not be conducted.

7. Radioactive powders, liquids, or solution are not to be used in a non-laboratory facility.

8. Scientific equipment such as bunson burners, hot plates, etc. must meet with approval of the
   Lansing Center and Radisson Hotel engineers (this is your responsibility).

1. Practice all demonstrations or workshops procedures BEFORE presenting them to an audience or having
   participants try them.

2. Research and understand the properties, chemical reactions, and dangers involved in all demonstrations.
   Plan to use correct handling procedures for all biohazards used. Arrange to have a fire extinguisher
   available whenever the slightest possibility of fire exists.

3. Prepare a handout that gives participants detailed instructions about the procedures, safety precautions,
   hazards, and disposal methods for each demonstration.

4. Prepare photographs, slides, videotapes, and so on that show safe science practices. When preparing
   these materials, safety goggles and equipment shall not be removed for aesthetic considerations.

5. In planning demonstrations and/or workshops, keep quantities of hazardous materials to a minimum.
   Use only those quantities that can be adequately handled by the available ventilation system. Do not
   carry out demonstrations that will result in the release of harmful quantities of noxious gases into the
   local air supply in the demonstration or other rooms. The following gases shall not be produced without
   using a fume hood: nitrogen dioxide, sulfur dioxide, and hydrogen sulfide. Volatile, toxic substances
   such as benzene, carbon tetrachloride, and formaldehyde shall not be used unless a fume hood is

6. Wear appropriate eye protection, an apron, and similar protective gear for all chemical demonstrations or
   when appropriate for other demonstrations. Provide eye protection, aprons, and safety equipment for
   participants who will be handling chemicals, hazardous substances, or working with flames.

7. Do not select “volunteers” from the audience. Assistants used in demonstrations shall be recruited and
   given the proper instructions beforehand.

8. Warn participants to cover their ears whenever a loud explosion is anticipated.

9. Use a safety shield for all demonstrations that involve the launching of projectiles, or whenever there is
   the slightest possibility that a container, its fragments, or its contents could be propelled with sufficient
   force to cause injury. Shield moving belts attached to motors. Use caution when motor-driven discs are
   revolved at moderate or high speeds. Shield or move participants to a safe distance from the plane of
   the rotating disc.

10. Follow proper procedures for working with pressurized gases.

11. Use appropriate gloves and shield when working with hazardous chemicals, cryogenic materials, hot
   materials, radioactive substances, vacuums, electromagnetic radiation, and when presenting animals
   for observation.

12. Do not taste or encourage participants to taste any non-food substance. A food subjected to possible
   contamination or unsafe conditions shall never be tasted.

13. Note clearly at the beginning of the program the presence or production of allergenic materials such as
   “theater” smoke, lycopodium powder, or live animals.

14. Maintain clear egress during the demonstration or workshop.

15. Emphasize and demonstrate appropriate safety precautions throughout the presentation or workshop.
    16. Distribute a handout that will give participants detailed instructions about the procedure, safety
        precautions, hazards, and disposal for each demonstration.

    Session Title: ____________________________________________________________________

                               SAFETY GUIDELINES: Presenter’s Signature Required

                                            MSTA 57th Annual Conference
                                           Radisson Hotel – Lansing Center
                                                 Lansing, Michigan

                                                    March 4-6, 2010

    Identify any potential safety hazards associated with your presentation.


    What precautions will be taken during the presentation to deal with these hazards and to inform the


    What safety equipment will be required?______________________________________________________


    I have received a copy of the “Minimum Safety Guidelines for MSTA Presenters and Workshop Leaders”
    and agree to comply with the guidelines during my presentation. IMPORTANT! Your signature is
    required below in order for MSTA to include your name in the final convention program (even if there
    are no special safety considerations applicable to your session).

    Signature_________________________________                 Date_________________________

    Any speaker form that is returned without the Minimum
             Safety guidelines will be returned.

       ***You must return even if you are ONLY doing a
                 speaking presentation***

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