--------- --- City Club Newsletter Submission Form

__________________________(Please provide the following information and then press submit.)

___Title for the Program:_

____________Speaker's Name: (e.g. Kitty Piercy)
____________Title: (e.g. Mayor)
____________Affiliation: (e.g. City of Eugene)
____________Address:
____________Phone:
____________Email:

Photo Available?     Yes   No        
Please email photos to City Club of Eugene at    this email address
Newsletter articles are greatly enhanced by photos of our speakers. If available, you can send photos to the newsletter staff electronically. JPEG or TIFF formats work best. Just send us an e-mail with the program date and the name of the person(s) in the photo. Attach the file to your e-mail and then send it to the address above.______C

____________First Questioner's Name:
____________Title: (e.g. Ed. Page Editor)
____________Affiliation: (e.g. Register Guard)


Program Description: (approx. 150 - 200 words)
Friday Forum  At Large Event
__Day (Friday)- -Date:- -Time (11:50)- Place (Downtown Athletic Club)-

__________
Additional Notes: (additional speakers, participants...)
Room Setup: (Podium, Speaker Table guests, Special Needs – i.e. dietary, seating, etc.)
Memo - (not for publication)

___________Submitted by:
___________Phone:
___________E-mail address:
___________Date:
I'm ready to send:    Yes    No