Chapter Meeting Request Form

Team Member Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Meeting Date*

Meeting START Time*

You should have your room reserved for 1hr+ on either end of your meeting time.

:

Meeting END Time*

You should have your room reserved for 1hr+ on either end of your meeting time.

:

Is this meeting virtual?*

Yes
No

Name of Venue for Meeting*

Meeting Address*

Street Address Address Line 2 City State ZIP Code

Special Parking Instructions*

Free Parking
Handicap Accessible
Other

Other? Please Explain*

Does your meeting have a speaker?

Yes
No, this is a group meeting

Speaker Name*

First Last

Speaker's Credentials*

Affiliated Center or Institution

Topic & Title of Presentation*

Anything else you would like included in the announcement?

Special directions, RSVP info, etc.

Radius of meeting invitations*

Default is to include everyone within 60 miles of your location, but can be customized to be smaller/larger, include whole state, etc.

Request Meeting Supplies*

Yes (will take you to F-9 Form)
Not at this time

F-9 Supplies Request Form

Please select from the drop down boxes below which supply items you will need for your meeting.

I request a speaker gift*

Yes
Not at this time

Number of Speaker gifts will you need*

Printed Materials*

Please note: we will send a limited number of printed materials.
Please check requested materials or select ‘I do not need any materials at this time’

Giveaway Items & Miscellaneous*

Pens
Bracelets
Chapter Meeting Sign
I do not need any giveaway items at this time

Do you need business cards?*

Yes
Not at this time

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Team Member Name

Hidden

Phone

Hidden

Email

Hidden

Time

Hidden

Date

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How many Speaker gifts will you need?

Chapter Meeting Request Form

F-9 Supplies Request Form

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