Form Host Organization Mission Statement for Organization Event Name Event Theme Start Date End Date Registration Fee Location (City/State/Country) Venue Website Attendee Profile (what type of organizations/firms will attend) Anticipated Number of Attendees Technical Content/Agenda for Event (presentations, workshops, special speakers) Has the Event Been Held Previously Yes No If Held Previously - Date of Last Event Names of Other Co-Sponsors List of Organizing Committee (indicate if Geo-Institute or ASCE members) Does this also include a request for an ASCE/G-I Publishing Proceedings (if yes, please be aware that the Executive Office cannot accommodate all requests) Yes No Individual to Contact Within Your Organization Name Title Organization Street Address Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Telephone Fax Email Contact's Affiliation with ASCE or Geo-Institute Board Member Committee Member ASCE/G-I Member Other None
