WDS Networking Reception Request Form | Events of the Women's Dermatologic Society

WOMEN’S DERMATOLOGIC SOCIETY
First come, first serve! Funds are limited, Act now!

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Women’s Dermatologic Society encourages members to host local receptions either in a private home or at a nearby venue. Applicants must fill out the form below and submit it for approval by the Networking Committee. Please allow up to eight (8) weeks prior to the planned event for approval and promotion of the event to occur.

These events are intended to be informal, however guest speakers may be invited. For more information, contact the WDS office at (415) 764-4925 or wds@womensderm.org – we are eager to hear from you if you are interested in hosting an event in your area!

EVENT INFORMATION:

Name of host(s):
Are you a WDS member?	Yes .... No

Proposed Date of Reception:	\| \|
Proposed Time of Reception:	to

Will a visiting WDS member be in attendance?	Yes .... No
If so, who is that member?

Is a formal talk planned?	Yes .... No
If yes, what is the title?

Anticipated number of attendees:
Is there a cap on the number of attendees?	Yes .... No

Anticipated total cost of reception:	$
Describe venue:	Describe venue here
Address of venue:	Address of venue here

APPLICANT INFORMATION:

Your Name
E-Mail Address:
Address:
City:
State:
Zip:
Telephone:
Fax:
Today's Date:	\| \|

ADDITIONAL COMMENTS:

List Details Here

PLEASE NOTE:
Please allow up to eight (8) weeks prior to the planned event for approval and promotion of the event to occur.