1. LECTURER INFORMATION:

 a. Lecturer name:
    

 b. Title of lecture:
    

 c. Time/date of lecture:
    

 d. Location of lecture:
    

 e. Duration of lecture:
    

 f. Expected audience:
    

 g. Parking Instructions:
    
        
 h. Zip code ranges within a ½ hr drive:

    to     from 
 
 i. Room Capacity:
    

2. CHAPTER INFORMATION

 a. Chapter name:
    

 b. Chapter e-mail:
    

 c. Chapter contact- primary (name, day and 
    evening phone, and mailing address):
    

 d. Chapter contact- secondary (name, day and 
    evening phone, e-mail and mailing address):
    

 e. Person meeting incoming flight: 
    

 f. Person escorting lecturer to airport:
    

 g. Number of "ACM Parent Organization" Members Served:
    

3. ACCOMMODATIONS

 a. Name of hotel/motel:
    

 b. Hotel mailing address: 
    

 c. Hotel phone number:
    

 d. Hotel fax number:
    

 e. Reservation confirmation number and contact 
    person:
    

4. ATTACHMENTS

 a. Copies of announcements/flyers/posters advertising 
    the lecture

    (by fax or mail)

 b. Local directions (if needed):
    

 c. Information on visitor parking permits (if required):