Evening Lecture Proposal Form
Please note: Lectures must be pre-approved by the Lecture Committee. This form if only to be filled out by Lecture Committee Members submitting information for their pre-approved lecture.
Committee Member Responsible for Speaker
*
Committee Member Phone Number
*
Committee Member Email
*
example@example.com
Speaker's Name
*
First Name
Last Name
Speaker's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Speaker's Phone Number
*
Speaker's Email
*
example@example.com
Will there be more than one speaker?
*
Yes
No
Speaker 2
*
First Name
Last Name
Speaker 3
First Name
Last Name
Speaker 4
First Name
Last Name
Speaker 5
First Name
Last Name
Title of Lecture
*
Title of 50 or fewer characters (including spaces) is required.
Would you like this to be an in-person or virtual (on Zoom) lecture?
In-person
Virtual (Zoom)
Do you have your own organizational/education Zoom license, or would you like to use Osher's Zoom license?
I would like to use my own licensed account.
I would like to use Osher's license.
What day of the week would you like to present your lecture?
*
Monday
Tuesday
Wednesday
Thursday
Friday
What date would you like to present your lecture? (Dates must be confirmed by the Osher office.)
*
What time would you like to present your lecture?
*
1:00 PM
3:00 PM
7:00 PM
Other
Description for website
*
Please provide one paragraph, maximum 150 words, that conveys the content of the lecture and will pique the interest of potential attendees.
0/150
Biography
*
Please write bio in 3rd person. Bio is limited to 150 words, whether for one or multiple presenters.
0/150
Picture of speaker for poster/website (Photo must be in JPEG format)
*
Upload A Photo
Please supply a high-quality photo. Ideally it should be 300 dpi and 8 in. X 10 in.
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