Scientech Club
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:
Phone:
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:
Comments:
In an emergency, when another speaker fails to appear as scheduled, can we fill in with this talk?:
Select One: NOT for Emergency Use OK To Be Used in Emergency Is ONLY for Emergency Use