Primary Contact Name *

Primary Contact Organization

Primary Contact Email Address *

Primary Contact Phone

Please list below any additional ASIS&T members engaged in this effort.

Proposed Meeting Location (City / State / Province / Country) *

Please explain why this location was chosen (eg. number of local ASIS&T members, etc) *

Proposed Meeting Month/Year *

Proposed Meeting Venue, if known

Anticipated Number of Attendees (approx)

Meeting Description *

Meeting Objectives (please list at least 3) *

Number of General Sessions (all attendees) *

Number of concurrent breakout sessions *

Describe below the overall format for the meeting *

(eg. general session, concurrent session, lunch, concurrent session...)

Registration Fees *

Describe below the typical meeting registration fees in this region for a similar meeting in terms of scope and length.

Other Revenue

Describe below any potential sponsors and anticipated sponsorship revenue.

Food & Beverage *

Describe below any meals and other food and beverage service that you anticipate including.

A/V *

Describe below any A/V needs beyond a projector and screen that you anticipate needing:

Additional Information

Please provide any additional information you would like considered in deciding upon your proposal to host a regional meeting.

I have read and agree to the ASIS&T Regional Meeting Guidelines (linked above). *

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