Distinguished Lecturer Submission Form

Nominee Information

Nominee Name (Last Name, First Name) (*)

Nominee Domain of Activity (*)

Nominee Occupation (*)

Nominee's Current Employer (*)

Nominee's Current Position (*)

Nominee Email Address (*)

Nominee Country

Nominee Website

Nominee Gender (*)
MaleFemale

Nominee IEEE Region: (*)

Choose 1 EMBS TC for Review: (*)

Nominee IEEE Member Number

Nominee IEEE Member Grade

Nominee is an EMBS Member? (*)
YesNo

Year of Nominee's Highest Degree (*)

Please enter the Nominee's lecture topics (up to three), with keywords and a short abstract for each.

Lecture Topic 1 Title (*)

Lecture Topic 1 Keywords (*)

Lecture Topic 1 Abstract (*)

Lecture Topic 2 Title

Lecture Topic 2 Keywords

Lecture Topic 2 Abstract

Lecture Topic 3 Title

Lecture Topic 3 Keywords

Lecture Topic 3 Abstract

Nominee's Teaching and/or Public Speaking Experience (*)

Summary of Nominee's EMBS Activities (*)

Upload your nomination packet below.
Please note that only PDF Files are allowed with a 2MB max for each file.

Nominee CV (PDF only) (*)

Nominee Photo (PDF, PNG, JPG, JPEG) (*)

Letters of Invitation (PDF, ZIP)
Upload any pre-approved letter of invitation to give a lecturer co-sponsored by a local IEEE Chapter.

Nominator Information

Nominator Name (Last Name, First Name) (*)

Nominator Affiliation (*)

Nominator Email Address (*)

Nominator IEEE Member Number

Is this an EMBS TC or Chapter-based nomination? (*)

If YES, please specify name of TC or Chapter:

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