NWABR - Education Materials

Ethics Lessons

HIV

Stem Cells

Other Lessons

Student Biotech Expo

Speakers' Bureau Questionnaire Form
You may also print and fax this form to 206-282-2214

Name:	Dr. Mr. Ms. Mrs.
Degree:		Position:
Organization:
Address:
City:		State:
Zip:
Telephone: (Day)		Telephone: (Evening)
Email:		Fax:
Best way to contact you:

I would most enjoy presenting on the following topics:
My area of expertise or experience is:

Please check all that apply:
I can do a hands-on activity with the audience
I am a patient who would like to share my story
I can speak about my research
My work involves animal models or animal care

Please check the group(s) you would most enjoy addressing:
Students & Teachers
Elementary School
Middle School
High School
Post Secondary

Community:
Service Clubs
Professionals
Patients
Volunteer Health Organizations

Please check the times you are available to give presentations:
Weekdays Evenings Weekends
Have you given presentations to classrooms or community groups before?
Yes No
Please indicate if you are willing to travel within Washington State?
Yes No
Would you be willing to talk with/assist new speakers?
Yes No

Please enter any additional comments or questions below:

Thank you for your interest in science education outreach!

For more information, please email us.

NWABR is a 501(c)3 organization. All contributions are tax deductible.
The NWABR web site was made possible by funding from the National Center for Research
Resources and the National Institutes of Health through a Science Education Partnership Award.