I am willing to respond to questions from the media: Yes No.

I am willing to speak to community groups: Yes No.

First Name: Initial:

Last Name:

Professor of:

Academic title:

Administrative titles:

Administrative titles, continued:

School(s):
Department(s):

Center(s):

Office phone:

Home phone:

Fax:

E-mail address:

Your Web Site URL:

Foreign language fluency? (Which)

Other countries where you lived? (Which)

Please email a brief biography to accompany your entry to Purdue News Service, purduenews@purdue.edu

Expertise: On what subjects might you talk to the media? Please use lay terminology and one to three words for each topic.

Expertise: On what subjects might you talk to community groups? Please use lay terminology and one to three words for each topic.

Stock presentations: Please provide titles for talks you can give to general community organizations.

Do you charge for public presentations? Yes No

        Thank you for your time!

(SPEAKER REGISTRATION FORM)