Proposal Form

1. First name, Middle Initial, Last Name: Address: Telephone:       Email: 2. Association/organization you want to deliver a Dorothy Dillon Eweson Lecture on the Advances in Aging Research before? 3. What is the name of their meeting, goals (if possible), date and location? 5. What is the expected number of attendees? 6. What types of medical professionals attend this meeting? 7. Please outline your suggested lecture or session on the advances in aging research. 8. Please provide AFAR with a total estimated budget for travel, lodging and honoraria (not to exceed $1500 US dollars). 9. Please provide us with a contact at the Association/Organization: Or print out and mail to: Catherine Cullar AFAR 55 West 39th Street, 16th Floor New York, N.Y. 10018 If you have questions please call Catherine Cullar (212) 703-9977