EMBS Distinguished Lecture Request/Approval

Today's Date: *

Requested Distinguished Lecturer: *

Event Name: *

Date of Event: *

Location: *

IEEE Region: *

What Technical Community does this represent: *

Host Contact Name: *

Host Contact Email: *

Hosting Chapter: *

Number of EMBS Chapter Members: *

Number of Expected Attendees: *

How will this benefit the chapter members? *

i.e., nature of the event, is it part of a larger conference, etc.

Amount of funding requested? *

What will the funding be used for? *

travel, housing, etc

*

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