Western Illinois University: Macomb Campus

Program Title: *

Short Description [topic of lecture, background or expertise of speaker, etc]: *

Date: *  (mm/dd/yyyy)

Time: *  (hh:mm am/pm)

Location: *

Sponsor(s): *

Type of Program (please check most appropriate): *

Admission Charge: *

Restrictions (if any):

Targeted Participants:

In case questions arise regarding this submission:

[For Consistency, it is suggested that one person serve as contact for each department or organization]

Contact Name: *

Contact Email Address: *

Contact Telephone #: *  (XXX - XXX - XXXX)

Department Office #: