Form

First name*

Last name*

Email*

Name of School, Department, Office or Lab*

Desired county, city, or venue*

Badger Talks has a list of 30 pubs around the state that have agreed to host events. Please indicate the area of the state that you want to reach. See here: https://docs.google.com/spreadsheets/d/1E5TSwP9IwfkeKLvc_lJ2pJvok7WHaNZcj9MZfDNGt2U/edit?usp=sharing

First speaker name*

First speaker email*

First speaker topic*

Second speaker name

Second speaker email

Second speaker topic

Third speaker name

Third speaker email

Third speaker topic

First Choice: Event Date*

Month/Day/Year

Second Choice: Event Date*

Month/Day/Year

Is there someone in your program who can emcee this event? If so, who?*