Cover page for Abstract Submission
complete the following information. It will automatically be sent by e-mail:
Your Name: required Member Number: Leave blank if not a member Street Address: Street Address: City: State: Zip or postal Code: Country: Email Address: required Home Phone:(Area Code) Work Phone:(Area Code) Fax Number:(Area Code) Preferred communication means with HPF committee: E-mail Telephone Title of presentation: Type of presentation: Aviation Vietnam Non-Aviation Vietnam Author/producer Presentation time reguested: 30 mins 60 mins Other: Special audio-visual support needed (explain):
I acknowledge that if selected as a speaker I will submit a slide presentation or 3-5 page summary no later than 1 June (presentation must be provided for electronic loading the day before scheduled - changes are allowed. Please check: YES Initials:
I acknowledge that if selected and scheduled to present, I will register and attend the VHPA Reunion (speakers must make every effort to present): Please check: YES Initials:
Please provide a short biography, especially as it relates to presentation:
Questions? Contact Dr. Jim Fulbrook, 703.385.2999, email@example.com, Fax 571.227.6009 Address: 3478 Barrister's Keepe Circle, Fairfax, VA 22031 Submit by 28 February 2006.
Send mail to firstname.lastname@example.org with
questions or comments about this web site.