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IWDC 2013 Bid Form

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First Name*
Last Name*
Employment Title*
Employer*
Mailing Address*
City*
State/Prov*
ZIP/Postal Code*
Country*
Telephone*
FAX
E-Mail*
Proposed City, State/Province, Country*
Proposed Venue (Facility)*
Proposed Conference Dates (dd-mm-yy - dd-mm-yy)*
Proposed Conference Theme*
Organizing Committee (Name, Organization - 1 to a line)*
Proposal Summary (250 words limit)*
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