CIM - Distinguished Lecturers Program Request

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PLEASE NOTE:
This form is not for CIM constituents. Branches are requested to fill up this form from their own Branch page. Societies please contact CIM.

CIM DISTINGUISHED LECTURERS REQUEST FORM

1. Invited by:
2. Person in charge of program:
Name, Surname
Telephone
Fax
E-mail
3. List of Distinguished Lecturers and presentation dates requested in order of preference:
Select First Lecturer	Preferred Dates
Select Second Lecturer	Preferred Dates
Select Third Lecturer	Preferred Dates
Select Fourth Lecturer	Preferred Dates
Select Fifth Lecturer	Preferred Dates
4. Time of Lecture
5. Location of Lecture