caBIG™ Speaker Request Form

Organization Information:

Name:
Location:

Contact Information:

Name:
Business Phone:
Fax Number:
Email Address:

Presentation Information:

Topic:
If requesting a specific speaker, please provide name:
Objective:
Date / Time of day:
Alt. Date 1 / Time of day:
Alt. Date 2 / Time of day:
Length of presentation: (50, 90 minutes, etc.?):
Audience:
Number of Persons expected to attend:
Confirmation from speaker needed by:
Please describe level of support, if any (Travel, Lodging, Honorarium)
Additional Comments:

last modified 11-22-2005 10:58 AM

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* As of September 2008,the trademarks for cancer Biomedical Informatics Grid^® and caBIG^® are registered by the U.S. Patent and Trademark Office The trademarks were pending completion of the registration until now. We will be reflecting this change on the caBIG^® web site materials and in other materials as rapidly as we can, but you may notice for the changeover period of time, the usage of both the pending ™ symbol and the registered ^® symbol in some materials. We will use the registered trademark symbol when referencing caBIG^® in new materials.

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caBIG™ Speaker Request Form