PSRC Speaker Biographical Information Form

The following information is required to obtain AARC approval for CRCEs. NOTE: Do not use punctuation in your information as it will not be accepted by the form...other than "/" or ")"

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1. Name of Seminar or Conference At Which You Are Presenting
2. Your Full Name
3. Credentials (if any) - Please separate with a "/" mark not a comma
4. Full Mailing Address
5. Preferred Phone Number
6. Email Address (if you don't use email, enter NONE)
7. Name of Employer & Your Current Position
8. Describe your familiarity with the audience at this event.
9. Please describe any vested interest you may have with this presentation. Enter NONE if you have no vested interest.