Henry Darcy
Distinguished Lecture Series in Groundwater Science
Request Form
The completion of this form is required in order for a site to be considered to host the lecture series.
Name of proposed host site ____________________________________________________________________________
Host site ____________________________________________ City _________________________________________
State/Province ______________________________________Country _________________________________________
Contact person _____________________________________________________________________________________
Name of company, organization, or university _______________________________________________________________
Mailing address 1 ____________________________________________________________________________________
Mailing address 2 ____________________________________________________________________________________
City ________________________________________ State/Province _________________________________________
Zip/Postal code ____________________________________ Country _________________________________________
Phone number __________________________________ Fax number _________________________________________
E-mail ____________________________________________________________________________________________
Desired date for lecture _______________________________________________________________________________
Optional dates ______________________________________________________________________________________
I have the authority to represent the above referenced company/organization/university. I understand that if chosen to host the
Darcy Lecture Series, my company/organization/university will provide the speaker with the following:
• Housing(roomandtax)forthelecturespeaker(usuallythenightbeforethelectureandthenightofthelecture)
• Mealsduringthelecturer’sstay
• Anyaudiovisualequipmentthatthespeakerneeds
• Returningthehostpacketmaterialswithintwoweeksofthelecturer’spresentation.
I agree to the above statement. ❍ yes ❍ no
The Darcy Lecture can only be scheduled and confirmed through NGWA.
Return the completed form to the Foundation administrator, via e-mail:
Rachel Geddes
E-mail: rgeddes@ngwa.org