ASID GEORGIA CHAPTER MEMBERSHIP NUMBER: (REQUIRED)

MEMBER/ORGANIZER NAME:

MEMBER/ORGANIZER COMPANY NAME:

MEMBER/ORGANIZER CONTACT EMAIL:

MEMBER/ORGANIZER PHONE:

MEMBER/ORGANIZER WEBSITE LINK:

EVENT | CEU NAME:

EVENT | CEU INFORMATION / DESCRIPTION: (25-50 words).

CEU COURSE TITLE (Required if applicable.)

CEU IDCEC CODE #: (Required if applicable.)

START DATE: (If this is a one day event, please list the same date for start and end.)

END DATE:

START TIME

END TIME:

RSVP LINK:

RSVP DEADLINE

IN-PERSON EVENT VENUE LOCATION

EVENT ADDRESS

CITY/STATE/ZIP CODE

VIRTUAL / ONLINE (IF APPLICABLE):

ONLINE EVENT PLATFORM

ONLINE ACCESS LINK

ONLINE EVENT - Other Necessary Credentials

IF COST TO ATTEND, PLEASE INDICATE MEMBER AND NON-MEMBER COSTS, INCLUDING STUDENT MEMBER AND NON-MEMBER FEES:

IF A POTENTIAL OR CONFIRMED ATTENDEE HAS QUESTIONS, WHOM SHOULD THEY CONTACT? If different than the member/organizer, be sure to list name and email address (and phone number too if you like).

IMAGE 1: MEMBER/ORGANIZER LOGO

IMAGE 2: OTHER SPONSOR LOGO