Regional Activity Request Form

Regional Activity Request Form

Submission of Form does not guarantee approval of the activity and/or date.
Hosting Committee Name
Select all committee's whose help would make the event a success.
Event Contact

First NameLast Name
Contact's Email
example@example.com
Who is the Secretarial Liaison for your committee?
Has the Secretarial Liaison been informed about this activity?
Activity Details
Type of Event
Expected Location
1st Choice Proposed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
2nd Choice Proposed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
3rd Choice Proposed Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hour MinutesAM/PM Option
Description of the Activity
How will the activity be promoted?

Other
Necessary Support Committees
Should be Empty: