Request to Host a Seminar/Scientific Talk

Request to Host a Seminar/Scientific Talk
Full Name of Host*

Title (Example: Prof, Mrs, Mr)First NameLast Name
Host's Email Address*
Please provide your UCT affiliated email address
Host's Affiliation*
Which IDM member group do you belong to?*
Is your speaker available during the Wednesday 13:00 - 14:00 slot?*

YesNo

Seminar Details
Indicate Preferred Wednesday 13:00 slot*

DayMonthYear
Date
Seminar Title *
Speaker Name *
Speaker Affiliation *
100-word Speaker Biography *

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Upload Speaker High-Resolution Photo *

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Additional Information
Scientific Talk Details
Suggested Date & Time of Scientific Talk*

DayMonthYear
Date
Hour Minutes
Does the scientific talk need to be CPD accredited?*

YesNo
Scientific Talk Title *
Speaker Name *
Speaker Affiliation *
100-word Speaker Biography *

0/100
Upload Speaker High-Resolution Photo *

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Additional Information
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