Copyright 2008 Janet Zadina, Ph.D. All rights reserved.
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Invite Dr. Janet Zadina
to speak to your group


As you are probably aware, there are many details that go into bringing a speaker for your group. Please complete this form and provide as much information as possible. This will assist us in determining whether Dr Zadina is available. Please be aware that this serves as an inquiry only and NOT a confirmation of appearance. This will merely assist us in doing all we can to meet your requested dates. Please answer the following questions and submit this form. Ones marked * are required and others are helpful, but optional. Upon receiving this completed form, we will contact you as soon as possible and answer any questions you may have. If you have any problems with this contact sheet, please email jzadina@uno.edu.
Please fill out the details below.


Organization  


Contact Name


Title


Department


E-Mail Address


City                                                                             State


Date(s) Requested (Please indicate "open" if your schedule is flexible.