ROCHESTER PAGAN PRIDE DAY 2005

WORKSHOP PRESENTERS INFORMATION/BIO

Please complete this form and mail in the enclosed self-addressed, stamped envelope to:

M´Lyssa c/o The Web PATH Center, Inc., 4030 Galen Rd., Clyde, NY 14433. Thank you for your cooperation.

P L E A S E P R I N T ALL INFORMATION.

DEADLINE: JUNE 1, 2005.

YOUR NAME ___________________________________________________________________

NAME (AS YOU WOULD LIKE IT IN THE PROGRAM) _________________________________________________

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MAILING ADDRESS ______________________________________________________________________________

CITY ___________________________________________________, NEW YORK ZIP ______________________

PHONE NUMBER ________________________________________ CELL _________________________________

BEST TIME TO REACH YOU _________________________________________

E-MAIL ___________________________________________________________________________________________

NAME OF WORKSHOP YOU ARE PRESENTING __________________________________________________

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BIO INFORMATION: Please include # of years practicing, any organizations or causes you are involved in or have founded. Basically, include any information about you that you would like included in our program . Thank you.

SYNOPSIS OF YOUR WORKSHOP

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Do you have any preference of when your workshop is scheduled?

_____________ Early afternoon ____________ Late afternoon

Do you require anything special for your workshop? (other than chairs/tables)

________Easel/Paper/Markers ________Electricity (only 1 shelter has electricity this year

Other (please specify) __________________________________________________________________________

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Rochester Pagan Pride Day will be held on Saturday, September 24, 2005 at Ellison Park off Blossom Road. Tentative times: 10-6PM