Guest Speaker Nomination Form Please complete this form to request NORC sponsorship for a guest speaker. Please enable JavaScript in your browser to complete this form.Nominee Name and Degree(s) *Institution *Field of Expertise *Potential Presentation Topic(s) *Preferred Forum *NORC-sponsored speakers are generally featured in Endocrine Grand Rounds, Endocrine Research Conference, or Nutrition Seminar. These forums tend to attract members of the NORC research base. Although these are the preferred options, other forums will also be considered. Please indicate your preferred forum.Guest Host *The local host will be responsible for arranging a meeting itinerary for the guest's visit and accompanying the speaker to and from meetings.Preferred Month to Visit *JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberSelect all that applyAre you requesting full NORC sponsorship for this guest? *YesNoIf requesting the NORC to co-sponsor, please list the other sponsoring department(s): *Approximately how much funds are you requesting from the NORC? *Estimate to include travel, accommodations and meals. Other commentsImportant contributions, notable achievements, why you are nominating, etc.Your Name *FirstLastYour Email *Your Division/Affiliation *Relationship to Nominee(friend, mentor, colleague, etc.)Submit
