ML22081A365
| ML22081A365 | |
| Person / Time | |
|---|---|
| Issue date: | 01/22/2022 |
| From: | John Lane Office of Nuclear Regulatory Research |
| To: | |
| Lane J | |
| References | |
| Download: ML22081A365 (1) | |
Text
NRC FORM 1105 U.S. NUCLEAR REGULATORY COMMISSION (11-2019)
RIC SPEAKER CONFIRMATION FORM
Session Information (Session Chair or Coordinator to Complete):
Session Date Time of Session (7:00, etc.) Session Number
Session Title
Name of Session Chair Phone Number of Session Chair E-mail Address of Session Chair
Name of Session Coordinator Phone Number of Session Coordinator E-mail Address of Session Coordinator
Speaker Confirmation Information (Speaker to Complete):
Please TYPE the requested information below. Please refrain from using abbreviations and ensure that acronyms are spelled out.
Applicable information will be used for the purpose of populating the on-line conference program.
Speaker's Full Name Speaker's Full Position Title Speaker's Organization Name
Speaker's Business Mailing Address (City, State & Zip code)Speaker's Business Telephone NumberSpeaker's Business E-mail Address
Speaker Presentation Information (Speaker to Complete):
Proposed Presentation Title
Speaker Biographical Information (Speaker to Complete):
Please provide a short biography in narrative form below. The information will be used for introductions at the conference and will be posted on the RIC public website.
Date Submitted: Please save form and submit via (MM/DD/YYYY) e-mail to: RICMST.Resource@nrc.gov
NRC Form 1105 (11-2019) Page 1 of 1