You will need to provide the contact information for the primary person. This information will be used for SESHA to contact the appropriate person with questions about the submission as well as for notification of acceptance or rejection.

*First Name:
*Last Name:
*Job Title:
*Company Address: (Include Full Name of Business Affiliation)
*City:
*State/Country:
*ZIP/Postal Code:
*Phone:
FAX:
*Email:

Course Coordinators

Type each coordinator(s) name all with initial capitals, last name followed by first name, in the appropriate box i.e., Zimmermann, Allison (Coordinator Box 1), Burk, Brett (Coordinator Box 2) and Schock, Dylan* (Coordinator Box 3). Use an * (asterisk) following the first name of the presenting coordinator if more than one coordinator is listed.

  *Coordinator 1
First name:
Last name:

Coordinator 2
First name:
Last name:

Coordinator 3
First name:
Last name:

*Affiliation Box

Type the affiliation(s), and location(s) in upper and lower case in the box. Do not include your department's name, the city or state when they are part of the institution(s) name, or the zip code when listing the address(es) of the author(s). Capitalization and punctuation must be as shown in the sample (White House, Washington, DC and Intel, San Jose, CA).

*Title Box

Enter the title of your course in the box in upper and lower case.

*Course Description Box

The description will be published as submitted in the Final Program. There should be no margin at the top; keep all text flush left. Enter only the single-paragraph body of the text in the box below. The total number of characters including course coordinators, affiliations, city, state, title, spaces, and course description is 2000.

*Target Audience (select one)

You will be required to select one target audience. The choices are:

EHS Management
Safety
Industrial Hygiene
Environmental
Emergency Response
Facilities Engineering
Occupational Health / Medical

*Target Audience Experience (select one)

Basic (Intended for ESH professionals with 0-2 years of experience. Attendee will not need much knowledge of the subject material being presented.)
Intermediate (Intended for ESH professionals with 2-10 years of experience. Attendee will need a good understanding of the general topic being presented but not the specific topic.)
Advanced (Intended for ESH professionals with 10 or more years of experience. Attendee will need an in-depth knowledge of the specific topic being presented.)

Final Notes

If you have any questions, please call the SESHA Secretariat at (703) 790-1745, FAX: (703) 790-2672. Key dates for PDC's are as follows:

• PDC Submittal deadline is 27 January 2012.
• Notification of final selection and acceptance of PDC's will begin in February 2012.
• Final determination on PDC enrollment/breakeven will be 24 February 2012.