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Request for consideration form
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Full Name
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Title
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Department
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Campus Address
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E-mail Address
Brief Bio (400 words max)
Title of Topic 1
Short Summary of Topic 1:
Credentials for Topic 1
Title of Topic 2
Short Summary of Topic 2:
Credentials for Topic 2
Title of Topic 3
Short Summary of Topic 3:
Credentials for Topic 3
I would like to be considered as a knowledgeable source only on the topics listed.
I would like to be considered as a volunteer for speaking engagements only on the topics listed.
I would like to be considered for both speaker and as a knowledgeable source on topics listed.
I give Trine permission to publish my contact info if I am selected to represent the university in this capacity.
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