Conference Request
Name
*
First Name
Last Name
Email
*
example@example.com
Business Title
*
Years in Role
*
Department
*
Bio
EH
EPI
GCD
GHP
HPM
IID
NUT
SBS
SPA
OFS
Manager Name
First Name
Last Name
Please list the conferences you’ve attended in the last 3 years paid for by school funds.
Conference Details
Name/Title of Conference
*
Conference Start
*
-
Month
-
Day
Year
Date
Conference End
*
-
Month
-
Day
Year
Date
Deadline to Register
*
-
Month
-
Day
Year
Date
Location of Conference
*
Venue
Street Address Line 2
City
State / Province
Postal / Zip Code
Local (Boston)
Regional (New England)
National (All Other)
Link to Conference or Seminar Information
*
Estimated Costs
*
(Please include registration fees, travel costs (ground transportation, airfare, hotels) and other incidentals.)
Breakdown of Costs
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How will this benefit you, your department and Harvard Chan overall?
*
In what setting will you share the information learned from this Conference or Seminar?
*
Departmental Approval
*
Browse Files
Example: PDF of an e-mail or signed letter
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For internal use only
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