Guest Speaker Nomination Form NORC

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�鶹��ý�� Nutrition Obesity Research Center

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NORC Guest Speaker Nomination Form

Please complete this form to nominate a speaker you'd like to have on campus to speak on a topic related to nutrition or obesity.

Nominee Name and Degree(s)

Institution

Filed of Expertise

Potential Presentation Topic(s)

Preferred Forum (select all that apply)

Endocrine Grand Rounds
Endocrine Research Conference
DRC Research in Progress
DRC Seminar Series
Nutrition Seminar
Other... This choice will expand a text box

Preferred time of year:

Fall
Spring
Summer
Indifferent

Guest Host

The local host will be responsible for helping coordinate the guest's meeting agenda including which faculty to meet and invite to dinners for the nights the guest is on campus. The host must also be available during the day of the guest’s visit to help them navigate campus and their meetings.

Are you requesting full NORC Sponsorship for this guest? (expenses include airfare, ground transportation, hotel, dinners, etc...)

If no, please list the other sponsoring department(s):

Your Name (First, Last):

Your Division/Affiliation

Relationship to nominee (mentor, colleague, friend, etc.)

Other Comments (important contributions, notable achievements, why you are nominating, etc.)

�鶹��ý�� Nutrition Obesity Research Center (NORC)

CU Anschutz Health and Wellness Center

12348 East Montview Boulevard

Aurora, CO 80045

norc@cuanschutz.edu

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NORC Guest Speaker Nomination Form

�鶹��ý���� Nutrition Obesity Research Center (NORC)

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�鶹��ý�� Nutrition Obesity Research Center (NORC)