Host Organization

Mission Statement for Organization

Event Name

Event Theme

Date(s)

Registration Fee

Location (City/State/Country)

Venue

Website

Attendee Profile (what type of organizations/firms will attend)

Anticipated Number of Attendees

Technical Content/Agenda for Event (presentations, workshops, special speakers)

Has the Event Been Held Previously
YesNo

If Held Previously - Date of Last Event

Names of Other Co-Sponsors

List of Organizing Committee (indicate if Geo-Institute or ASCE members)

Does this also include a request for an ASCE/G-I Publishing Proceedings (if yes, please be aware that the Executive Office cannot accommodate all requests)
YesNo

Individual to Contact Within Your Organization

Name

Title

Organization

Address

City

State

Zip

Telephone

Fax

Email

Contact's Affiliation with ASCE or Geo-Institute
Board MembersCommittee MemberASCE/G-I MemberOtherNone