Distinguished Visitors Program Speaker Request Form

Please complete all information requested below (cut and paste into an email).

CHAPTER INFORMATION

Name of Chapter:

Chapter Chair:

Chapter Address:

Chapter Officer Filing Request:

Office Held:

Email:

Phone:

SPEAKER INFORMATION

Speaker:

Date of Speech:

Preferred Topic:

Estimated Inter-city Travel Cost:

Est. Local Expenses:

Expected Attendance:

______________________________________________________________ 
Signature (Chapter Officer submitting request) and Date

IMPORTANT: All speaker visits must be approved in advance by the DVP Chair. The Computer Society reimburses up to a maximum of $1,000 US for inter-city travel for approved visits to Computer Society professional and student Chapters. Local expenses are paid by the local Chapter. Arrangements made by speakers, Chapters, and/or others outside of DVP rules and guidelines are not the responsibility of the Computer Society. See current year's DVP catalog for complete program policies and procedures.

Complete (Copy and paste the form onto a word doc) and send this request to: Patricia Edwards