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* 1. Name:

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* 2. The MIT Alumni Association produces dozens of annual events itself and sponsors/coordinates several hundred others around the world each year. Are you interested in participating in the following alumni programs as a speaker? (Please check all answers that apply.)

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* 3. The Alumni Association often considers organizing alumni receptions during major events and conferences. Please let us know if you will be at any of the following and might want to attend or speak at an alumni gathering.

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* 4. Your travel schedule: We would like to know your planned travel for February 2019 and later. If you are interested in speaking to MIT alumni while traveling, please indicate your travel plans. Regardless, we keep calendars of faculty members' public talks/conference keynotes for alumni around the world to view.

We are particularly interested in international travel and in appealing to alumni communities which don’t often field MIT faculty speakers, such as: Chicago, Las Vegas, Salt Lake City, southern Europe, and Latin America. 

Please list the cities you are planning travel to or let us know where we might find that information elsewhere.

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* 5. Lecture topics/Book Tours: What topics would you prefer to speak about? Please include any new research, talks, or books coming out that might interest alumni.

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* 6. Webcasting of existing events: the Alumni Association dedicates a portion of its live-streaming budget to broadcasting existing events live to alumni. Are there conferences, events, or talks you will produce or partake in this year that you think should be made available to a wider audience?

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* 7. Referrals. Please name any former students of yours, whether in academia, government, or industry, whom you think the Alumni Association should consider spotlighting in its regional and virtual programming this year. 

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* 8. Please share any additional comments or questions. If you have feedback about an alumni/donor event at which you spoke in the past, please share that here.

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