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Last Name: / First Name: / Title: Mr. Mrs. Ms. Dr.
Florida Address:
Address Line 2:
City/State/Zip:
Telephone/Fax:() - () -
Email:
Residency: Full Time Jan – May Oct - May
(Select One) / Alt Address:
Alt Address 2:
City/State/Zip:
Alt. Telephone:() -
Alt. Fax:() -
Term:Please consider teaching in at least two of our terms. Please mark your selections:
Winter/Spring 18 (Jan - May) Summer 18 (May - August) Fall 18 (Sept - Nov)
Locations:Please consider offering your course in at least two of our locations. Please mark your selections.
Naples Center (downtown) Atrium Exec Center (S Ft Myers) Herald Court Centre (Punta Gorda)
The Arlington (SE Naples) Bentley Village (N Naples) Brooks Commons Club (Bonita Springs)
FGCU Main Campus (S Ft Myers) Moorings Park (S Naples) The Terraces (Bonita Springs)
Presentation Category: ArtBusinessComputers/TechnologyDay Trip/Special EventEcology/EnvironmentFilmHistory/Law/Gov'tLife EnrichmentLiterature/LanguageMusic/DancePhilosophy/ReligionPsychology/SociologyScience/MedicineU.S./World AffairsWriting
Presentation Title:
Number of Sessions: One Two Three Four Other
Session Length: 1 hour 1.5 hours 2 hours Other / Max # of Students (if any):
Preferred Start Date: / / / Preferred Days: Monday Tuesday Wed Thurs Friday
Preferred Start Time: Morning Afternoon Evening Other
Dates Which I am Definitely Unavailable:
AV or Other Requests (projector, lectern, microphone, etc):
Requested Room Setup (theatre style, podium, circle of chairs):
Description of Presentation for Publishing in the Catalog (75 words or less):
Biography for Publishing in Catalog (30 words or less):
Anyone you would suggest we contact regarding the possibility of teaching a Renaissance Academy class?
Name: Tel: () - Email:
FOR OFFICIAL USE ONLY: DOW: TIME:
LOC: DATES: CAT: FEE:
NOTES:
Please contact John Guerra at 239-287-5196 or with any questions regarding this form. Revised: 9/21/17