Wertheim Leadership Lecture Series Speaker Nomination Form

Please note that the Wertheim series will take place on Tuesdays from 12 pm to 1 pm EST. There will be two seminars per month.

Nominator Full Name
Office Phone Number Office Phone Number - ### - ### ####
Cell Phone Number Cell Phone Number - ### - ### ####
Email
Academic Rank
Department
Speaker Full Name
Speaker Academic Rank
Speaker Institution
Speaker Department
Speaker Email
Speaker Phone Number Speaker Phone Number - ### - ### ####
Speaker Lecture Title
Abstract
Maximum of 100 words allowed. Currently Entered: 0 words.
Speaker Bio
Maximum of 100 words allowed. Currently Entered: 0 words.
Speaker Professional Headshot

Attach Files

5 MB Limit
Speaker CV

Attach Files

5 MB Limit
Preferred Month for Presentation

Presentations are Tuesdays from 12-1pm.
Preferred Year for Presentation
Explain the impact that this seminar topic would make on attendees
Maximum of 100 words allowed. Currently Entered: 0 words.