American Conference of Governmental Industrial Hygienists (ACGIH®), your industrial hygiene, environmental, occupational health and safety resource that advances worker health and safety and offers books, conferences, and education and training courses.

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Education & Events


Speaker and Events Request Form

This form is meant for the encouragement of Symposiums, Workshops, Seminars and Conferences and Speaker requests.

Fill in the following worksheet, and select the "Submit Form" button.

First Name:
Last Name:
Organization:
Dept./Division:
Street Address:
City:
State:
Postal Code/Zip:
Country:
Voice Phone: (optional)
Fax: (optional)
E-mail address:

Purpose and Focus

Type of Request:
Speaker Conference Symposium Workshop

What is the name of this event?

What is the purpose of this event?

Reasons why this proposed event will contribute to the body of knowledge in OH&S.

What will be the focus of the event? Describe the content of the sessions.

Logistics

What location is preferred and why?

Second choice of location:

What dates are preferred and why?
(NOTE: Dates must be at least one year from submittal)

Second choice of dates:

Projected attendance:

Proposed format—conference, seminar, symposium, course, etc.:

Reasons why this format is preferred:

Tentative Program Schedule

How many days?

General/Plenary Sessions (How many per day?)

Concurrent Sessions (How many per day?) (*number of speakers or
presentations and time allotment)

Tutorials (How many per day?):

Roundtables or Discussions (How many per day?)

Target Audience(s)

Description of potential audience:

Possible sources of additional funding and contact name(s):

Recommendations about places/ways to advertise/market the event:

Please click the "Submit Form" button only once.

For more information, contact ACGIH® at http://www.acgih.org/contact/contactconffrm.htm.

Last update on 05/01/2006. Questions or problems? Please contact us. © 2013 American Conference of Governmental Industrial Hygienists, 1330 Kemper Meadow Drive, Cincinnati, Ohio 45240, 513-742-2020. ACGIH® and related marks are marks of the American Conference of Governmental Industrial Hygienists. All Rights Reserved. Terms of Access. ACGIH® Privacy Policy. Site Map.