Your name

Your contact information

• E-mail address
• Phone

Proposed Speaker/Discussion leader

• Name
• Current position
  • Organization
  • Title
  • Responsibilities

Proposed topic for meeting

• General description
• Possible title for event
• Three key points to be made by speaker that will foster lively discussion
  
• Why the topic should be of interest to a lay audience
  

Background of Proposed Speaker

• Education (universities and degrees)
  
• Subject expertise
  • Relevant publications or citations, including interviews in scientific or lay media (list 2-3 and provide links if possible)
    
  • Honors/recognition
    
• Books authored, including titles in circulation and any to be published within the next six months
  

Thanks for your suggestion.  Nancy, Roger and Catherine will discuss your proposal and will be in touch with you as soon as possible.