Symposium Proposal Submission Form

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NOTE: If you are not currently an ASPET member, you must either join or have this session co-submitted by an ASPET Member.
Co-submitted by
  
First Name
Last Name
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*Division
*Proposed Symposium Title
*Submitted By
Co-sponsored by what other Divisions
Program Justification
Format
  • Please note that in order to receive travel reimbursement, speakers must speak for a minimum of 20 minutes. If a speaker is also moderating a panel, or serving as a discussion group facilitator, the time for this activity may be included.
Junior Speakers
From submitted Abstracts
If not from submitted abstracts,
how will junior speakers be selected?

Proposed Speakers 

  

Speaker 1

  
*Name
Department
Institution
Address
Phone
Fax
*Email
*Title of Talk
Description of Talk
Length of Talk
  • Must be at least 20 min to qualify for travel reimbursement

Speaker 2

  
Name
Department
Institution
Address
Phone
Fax
Email
Title of Talk
Description of Talk
Length of Talk
  • Must be at least 20 min to qualify for travel reimbursement. 

Speaker 3

  
Name
Department
Institution
Address
Phone
Fax
Email
Title of Talk
Description of Talk
Length of Talk
  • Must be at least 20 min to qualify for travel reimbursement.

Speaker 4

  
Name
Department
Institution
Address
Phone
Fax
Email
Title of Talk
Description of Talk
Length of Talk
  • Must be at least 20 min to qulify for travel reimbursement.

Speaker 5 (optional)

  
Name
Depatment
Institution
Address
Phone
Fax
Email
Title of Talk
Description of Talk
Length of Talk
  • Must be at least 20 min to qualify for travel reimbursement.

Alternate Speakers

  

Alternate for Speaker 1

  
Name
Depatment
Institution
Address
Phone
Fax
Email

Alternate for  Speaker 2

  
Name
Department
Institution
Address
Phone
Fax
Email

Alternate for Speaker 3

  
Name
Department
Institution
Address
Phone
Fax
Email

Alternate for speaker 4

  
Name
Department
Institution
Address
Phone
Fax
Email

Alternate for Speaker 5

  
Name
Department
Institution
Address
Phone
Fax
Email
   
Preliminary Financial Requirement
  • Symposia are allocated a maximum of $4800 plus registration.


Organizer/Chairs

  

Organizer Chair 1

  
*Name
Department
Institution
Address
Phone
Fax
*Email

Organizer Chair 2

  
Name
Department
Institution
Address
Phone
Fax
Email

 

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