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NCCIH Director Speaker Invitation Form

  • Federal employees cannot accept complimentary travel, lodging, registration, or honoraria.
  • Please communicate all changes to the event as soon as possible.  
  • If you have questions, please contact Dr. Mark Pitcher

Inviting Organization Information

Is the inviting organization registered as a lobbying organization?
Is the individual issuing the invitation a registered lobbyist?
Is the inviting organization a 501(c)(3) organization?
Is there a fundraising component to this event?

About the Event

(0/125 words)

Pre-event coordination meeting required?

Timing of Remarks

Event Location

Is the event virtual or in person? (Virtual/In Person/Both)

Audience Details

Event Promotion, Ticketing, and Registration Details

Do you plan to share Dr. Langevin’s slides?

Press Details

Event Point of Contact

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