Request for Kepler speaker Required items marked with red asterisk {*} {*} Person filling Out Form (First & Last Name): {*} Email of Person Filling Out Form: {*} Organization: {*}Address: {*} City:    {*} State: {*} Zip:      {*} Phone: {*} Type of audience (e.g. university students, teachers, engineering society, amateur astronomers, public, etc.): {*} Estimated size of audience: Venue for presentation {*} Institution where event will be: {*} Venue Address: {*} City: {*} State: {*} Zip: {*} Date(s) of event: {*} Date(s) firm or flexible? Firm Flexible (if explanation needed,     add that in "Other information" box below) {*} Can you provide travel expenses, and/or an honorarium? Would you consider a teleconference presentation for your group? Yes No Need more info Other information: to Kepler Speakers Bureau, SETI Institute If you have questions, contact us via e-mail: edevore@seti.org Form updated 19 Dec 2007