E/PO Event Tracking

Submit an Outreach Event for Tracking — Venus Express

This form is provided for online
submittal of information regarding Venus Express education & public
outreach talks and events pertaining to Office of Space Science Education
(OSSE) at the Space Science and Engineering Center, University of
Wisconsin-Madison. OSSE will submit this information to NASA
as required . Thank you for taking the time to provide this information.

NOTE: All information
is required unless otherwise indicated.

PRIMARY PRESENTER

Name of Presenter:


Prefix	First	Last	Suffix (if applicable)

Presenter Affiliation:

Primary Role of Presenter:

E-Mail Address of Presenter:

Presenter Phone Number:

(optional)

Remember contact information in this form:
Yes

Names of Additional Presenters:

INFORMATION ON EVENT

Name of Event:

Begin Date of Event:

End Date of Event:

Event Type:

Where the Event Took Place:

		US zip code look up
City	State/Province	Zip/Post Code

Country

Type of Facility Where Event Occurred:

Topic Areas Covered in Event: (Check all that
apply)

Science

Mathematics

Technology

Engineering

Other

Number of People in Audience:

Type of Audience:

Event Sponsored by (Organization Name):

Contact Person at that Organization:

Name:
Address:	(optional)
Telephone Number:	optional
E-Mail:	optional

Event Activities: (Check
all that apply)

Lecture

Video

Demonstration

Group
Discussion

Audience
Q/A

Hand-On

Tour

Other

Materials Distributed: (Check
all that apply)

Fact Sheets	Videos	Posters/Postcards	Lithographs
CD-ROMs	DVDs	Lesson Plans	Other

Brief Description/Overview of Activity / Presentation:

characters left

URL of web page that has more info:

When Form is Completed, Click Submit!

Questions?

Please contact OSSE via e-mail at billb@ssec.wisc.edu

or by phone at (608)265-4160
Site Last Verified: November 11, 2008