Event Planning Template

Question Title

* 1. What is the Panel Title? w 0

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* 2. Panel Abstract (150 words or less) w 0

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* 3. Panel organizer: w 0

Name:

Company:

Address:

Office Phone:

Mobile Phone:

E-mail:

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* 4. For Each Proposed Panel Member (up to 6): w 0

Name (Panel Member 1):

Title (Panel Member 1):

Organization (Panel Member 1):

Panel Role (Moderator or Panelist 1):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 1):

Brief Bio (100 words max.)(Panel Member 1):

E-mail(Panel Member 1):

Position Statement (under 25 words)(Panel Member 1):

Name (Panel Member 2):

Title (Panel Member 2):

Organization (Panel Member 2):

Panel Role (Moderator or Panelist 2):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 2):

Brief Bio (100 words max.)(Panel Member 2):

E-mail(Panel Member 2):

Position Statement (under 25 words)(Panel Member 2):

Name (Panel Member 3):

Title (Panel Member 3):

Organization (Panel Member 3):

Panel Role (Moderator or Panelist 3):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 3):

Brief Bio (100 words max.)(Panel Member 3):

E-mail(Panel Member 3):

Position Statement (under 25 words)(Panel Member 3):

Name (Panel Member 4):

Title (Panel Member 4):

Organization (Panel Member 4):

Panel Role (Moderator or Panelist 4):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 4):

Brief Bio (100 words max.)(Panel Member 4):

E-mail(Panel Member 4):

Position Statement (under 25 words)(Panel Member 4):

Name (Panel Member 5):

Title (Panel Member 5):

Organization (Panel Member 5):

Panel Role (Moderator or Panelist 5):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 5):

Brief Bio (100 words max.)(Panel Member 5):

E-mail(Panel Member 5):

Position Statement (under 25 words)(Panel Member 5):

Name (Panel Member 6):

Title (Panel Member 6):

Organization (Panel Member 6):

Panel Role (Moderator or Panelist 6):

Status (TBD, Tentative, Confirmed, etc.)(Panel Member 6):

Brief Bio (100 words max.)(Panel Member 6):

E-mail(Panel Member 6):

Position Statement (under 25 words)(Panel Member 6):

Question Title

* 5. Proposed Panel Format or Special Requirements: w 0

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* 6. 4. For Each Proposed Panel Member (up to 6): w 0

Name:

Company:

Address:

Address 2:

City/Town:

State:

ZIP:

Country:

Email Address:

Phone Number: