Congress to Campus Request Form

Please accept our request for a Congress to Campus session at:

(Name of school)

Host Contact Name

First Name

Last Name

Host Contact Title

Host Contact Campus Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nearest Airport(s) To Campus

Host Contact Email

Host Contact Phone

(###)

###

####

Our preferred format is

In-person visit

Virtual session (s)

Hybrid (both in person and virtual)

Ideal dates for our session

Please tell us what you hope to achieve with your Congress to Campus session(s)

We hope to cover the following topics and hold these activities:

We understand there is a $3,000 program fee and we must also cover all hosting costs and

We have sufficient budget to cover all costs for our preferred format

How did you hear about Congress to Campus?

*All Former Members donate their time to this program pro bono, and none receive an honorarium for their participation. FMC is a non-profit and the $3,000 administrative fee goes toward covering our own costs including staff time, overhead, travel for two former Members to and from the participating school, etc.

*Please note that although FMC will try to accommodate a school’s request for specific Former Members, for various reasons we cannot promise a specific member’s participation.

Request to Host a Session

Congress to Campus Request Form

FMC