Connexx Event Proposal Form

Your Information
Chapter or Section:
Contact Name:
E-mail:
Phone:
Event Information
Date(s) and Time(s):
Does your event require funding?	Yes No Amount Requested:
Are any other organizations involved in planning this event?	Yes No If yes, please list organizations here:
Event Venue:	Event is virtual and does not require a physical location.
Event Title:
Event Description:
Topic/Content:
Proposed Speakers or Participants:
Will content be captured for future use, and if so, how?	Yes No Details:
Estimated Attendance:
Estimated Expenses:
Estimated Revenue:
Is online registration required?	Yes No
Do you require additional IDSA support (conference calls, etc.)?	Yes No Details:
Additional Comments: