Faculty Forum Speaker Application

Speaker Information

First Name

Last Name

Title and Department

Daytime Phone

Address

Address 2

City

State/Province/Region

Zip Code

Country

Are you a current member of the Alumni Association? (Membership is required prior to speaking.)

YesNo

University of Michigan Degrees

*U-M Degree is not required to be a Faculty Forum speaker.

U-M School/College

U-M Degree

U-M Graduation Year

Michigania Speaking Experience

Have you previously spoken at Michigania?

YesNo

Have you spoken at other Alumni Association programs, such as club meetings, travel programs, alumni education seminars, etc.?

YesNo

Would you be interested in speaking at other Alumni Association programs?

YesNo

Presentation Content Info

Background and Area of Expertise

Please provide more detailed information on your background and area of expertise. Feel free to include website links as well. You may enter up to 500 characters.

Proposed Talk Title #1

Upload Abstract for Proposed Talk #1

Proposed Talk Title #2

Upload Abstract for Proposed Talk #2

Proposed Talk Title #3

Upload Abstract for Proposed Talk #3

Note: We will be contacting all prospective faculty speakers in October and November. If you have any questions, please contact [email protected].

Date Preferences

Please select three week options when you are available to speak.

Date Choice 1

Date Choice 2

Date Choice 3