Funds Request - Not Associated

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Request for Program Funds for the 2014 MLA Convention
Chicago, 9–12 January

See section 2 of the “Procedures for Organizing Meetings at the MLA Convention” for guidelines on applying for these limited funds for nonmembers. MLA members and allied organizations are not eligible for funding. Requests must be submitted by 15 April 2013.

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Please complete all sections of this form and click Continue. Once you submit your request you will be able to preview it in the format in which it will be presented to the Program Committee. You will then be able to edit your request before final submission. Please print a copy of this form for your records before submitting.

Title of meeting:

Type of meeting:

MLA member responsible for making program arrangements or for getting in touch with speaker:

Name:
Affiliation:

E-mail:

Alternate e-mail:

Current mailing address:

City:

State:

Zip code:

Country:

Home phone:

Office phone:

Fax:

Summer e-mail:

Summer address: same as current

Summer city:

Summer state:

Summer zip code:

Summer country:

Summer home phone:

Summer office phone:

Summer fax:

Dates of summer address:

Start:

End:

Proposed speaker:

First Name:	Last Name:	Affiliation:
E-mail:	November e-mail:

Please provide a current mailing address for the nonmember and an address to which the convention badge and program should be sent in early November. Check Same as Current if appropriate.

Current mailing address:

City:

State:

Zip code:

Country:

Home phone:

Office phone:

Fax:

November address: same as current

November city:

November state:

November zip code:

November country:

November home phone:

November office phone:

November fax:

Please state the speaker's profession or title and explain how his or her participation would enrich the program.

In the field below, please type or paste the text of the proposed speaker's curriculum vitae or professional résumé.

For foreign (not US or Canadian) speakers only:

Does the speaker have an academic affiliation in the US or Canada?

Yes

Has he or she taught or lectured in a US or Canadian university in the past five years?

Yes

Does he or she plan to teach or lecture in the US or Canada this year or next?

Yes

Support requested: (Please note funding is usually under $300.)

Travel expenses $

Total $

Hotel room:

Your contact information:

Phone:

Fax:

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