Local Section/Student Chapter
Host A Traveling Lecturer Form

Please complete the following information and submit to OSA for approval.  Forms must be submitted 60 days prior to the scheduled event.  No reimbursement will be authorized without prior approval from OSA.

All fields marked by an * are required

* Name of Section/Chapter

* Contact Person:

* Phone Number:

* Email Address:

* Speaker’s Name:

* Speaker’s Email Address:

Speaker’s Phone Number:

Speaker’s Address:

* Lecture Date:

* Lecture Time:

Lecture Title:

Other Comments: Limit: 100 words