Special Lecture/Event Proposal Form

Osher Lifelong Learning Institute at Dartmouth

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* 1. Please enter lecturer's contact information:

Name

Email Address

Phone Number

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* 2. Please provide a head shot of lecturer.

PNG, JPG, JPEG file types only.

Choose File

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* 3. Lecture Title

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* 4. Lecture Description
1,500 characters or less (includes spaces)

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* 5. Lecturer Biography
500 characters (includes spaces)

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* 6. Preferred dates & times

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* 7. Notes on transportation and travel

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* 8. Hotel needed?

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* 9. Equipment Needed

Microphone (s)

Lectern

Laptop

Sound

None

Other (please specify)

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* 10. Book signing?

Yes

50% of survey complete.

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* 1. Please enter lecturer's contact information:

Question Title

* 2. Please provide a head shot of lecturer.

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* 3. Lecture Title

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* 4. Lecture Description1,500 characters or less (includes spaces)

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* 5. Lecturer Biography500 characters (includes spaces)

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* 6. Preferred dates & times

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* 7. Notes on transportation and travel

Question Title

* 8. Hotel needed?

Question Title

* 9. Equipment Needed

Question Title

* 10. Book signing?

* 4. Lecture Description
1,500 characters or less (includes spaces)

* 5. Lecturer Biography
500 characters (includes spaces)