Guest Speaker Form Weber Lecture Series – Web-Based Lecture GUEST SPEAKER INFORMATIONNAME * Required First Last TITLE * RequiredCORRESPONDENCE/BUSINESS ADDRESS * Required Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code EMAIL * Required Enter Email Confirm Email PREFERRED CONTACT NUMBER * RequiredThis number will be used during the lecture if there is a connection/technical problem.SHORT BIO TO BE INCLUDED IN PROGRAM * RequiredMax. file size: 5 MB.PHOTO * RequiredMax. file size: 5 MB.This photo will be used for Online Event Advertising, Programs and Posters (500 or more pixels wide)LECTURE INFORMATIONTITLE OF LECTURE * RequiredSHORT DESCRIPTION * RequiredTECHNOLOGY INFORMATIONPREFERRED MEDIA PLATFORM * RequiredARE YOU PLANNING TO USE MEDIA SLIDES DURING YOU LECTURE? Yes No CAN THIS LECTURE BE RECOREDED? Yes No REQUIRED W-9 TAX FORM https://businessoffice.kzoo.edu/wp-content/uploads/sites/80/2020/03/Form_W_9_K_College_rvsd_10_2019-a11y.pdf WAS THE W-9 COMPLETED AND SUCCESSFULLY SUBMITTED TO THE BUSINESS OFFICE USING THE LINK ABOVE? Yes, I received a confirmation email. No, I submitted it but have not received the confirmation email. No, the link is not working. I would like a PDF emailed to me to fill out and sent back to you. Δ
