Organization Name
*
Organization Website
Please describe your organization
*
Host Contact First Name
*
Host Contact Last Name
*
Host Contact Email
*
Host Contact Phone
*
Event Title
*
Event Date
*
Event Time
*
9:00 AM
9:30 AM
10:00 AM
10:30 AM
11:00 AM
11:30 AM
12:00 PM
12:30 PM
1:00 PM
1:30 PM
2:00 PM
2:30 PM
3:00 PM
3:30 PM
4:00 PM
4:30 PM
5:00 PM
5:30 PM
6:00 PM
6:30 PM
7:00 PM
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Will media be present?
*
Yes
No
To be confirmed
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Organization Address
*
Event Location
*
Audience and notable invitees (include estimated number of attendees)
*
Description of the event (include proposed role for Dr. Soaries)
*
Formal Invitation Letter (PDF Format; 2MB max)
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