Scientech Club 

Program TALK Proposal Form
    Underlined items are Required.

                                             Enter your name and email address:                        

                           Sponsor:       Email:     

                                             Enter your speaker's name, email address (for a thankyou email from our president)
                                                           and phone number:

                           Speaker:       Email:     


                                             Enter your speaker's title, organization, position, etc.:
                                            (e.g., Phd., Indiana University, Geology Professor in the Department of Earth Sciences)

           About the Speaker:  

                                             Enter a title for the talk:

                Subject of Talk

                                             For our Members -- Enter a brief description of the talk:    

                Brief Summary:      

                                             For our Programs Committee -- If you wish, enter any comments here:    


                                            In an emergency, when another speaker fails to appear as scheduled, 
                                                          can we fill in with this talk?:

                         Select One: