Request for Meeting Support Form-Non ACS

Title of Conference*
Date of Conference*

i.e. June 12-15, 2025
Location*

Building, Campus, City, State, Country
Website

List the website describing the upcoming conference. If there is not a website, please explain in the comments below.
Name of Organizing Chair/Requestor*
Prefix First Last
Email*
Phone number for the Organizer*
List of Speakers*
Name Affiliation ACS Number DOC Members (Y/N)

Add one row for each speaker.
Diversity Statement*
Describe in 500 characters or less on how the selection of speakers will represent the Division's diverse population.
Additional Info/Comments for the Committee

Name	Affiliation	ACS Number	DOC Members (Y/N)