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Electronic Proposal Submission Form

 

Please fill out the following information before you submit the form.

(All Fields Required) 

PIPELINE 6: Process Technologies & Purification
 

 

Proposal Title:
 

3-5 Sentence Summary:
 

Why your proposal should be considered:
 

What the audience will gain from your presentation:
 

Short Bio: (Bio may be used in print material if proposal is accepted)
     
 


                             

First Name:

 

Last Name:

 

Degree / Credential: (eg. Ph.D. or FACR etc.)

 

Job Title:

 

Department:

 

Company/Organization:

 

Mailing Address:

 

City:  
State or Province (Canada):  
Zip / Postal Code:  

Country:

 

Phone:

Ext:  

Fax:  

Email:

 

Your Organization Website: