Apply to Host the 2010 Summit

An application form to host the National Smokeless & Spit Tobacco Summit in 2010.

The deadline for submitting applications is January 10, 2010.

Please complete the form below to submit your application. You can also click here for a printable version of the application in Microsoft Word format.

Entity Applying to be Summit Host/Sponsor: (Required)

Organization Address: (Required)

Organization City: (Required)

Organization State: (Required)

Organization ZIP: (Required)

Contact Name: (Required)

Contact Phone: (Required)

Contact E-Mail Address: (Required)

Responsible Agency/Division: (Required)

(Staff who will perform the work.)

What would be your goals for the conference? (Required)

How would you evaluate whether you met the goals of the conference? (Required)

Does your state have a significant problem with spit/smokeless tobacco? (Required)

Describe how collaboration with other partners would be approached? (Required)

How would disparate populations be a part of the Summit? (Required)

What workshop tracks or topics would you consider priorities? (Required)

Are there staff in place (or plan to hire staff) to coordinate the Summit? (Required)

If so, please describe.

Does your organization have the ability to publicize all information and have registration forms and other documents on a website? (Required)

If so, please describe.

Explain what experience your organization has with conference planning. (Required)

What is your organizational ability to recruit national partners? (Required)

In what ways is your organization willing to work with the Summit Advisory Board so that there is continuity in planning? (Required)

What are the motel/housing and travel options in your area? Is there a major airport nearby? (Required)

How do you anticipate paying for the Summit? (Required)

What is your organizational experience with the subject material? (Required)

Please include other information which you believe would add merit to your application to host the 2010 National Smokeless and Spit Tobacco Summit.

Other Optional Attachment:

For more information contact Niki Sue Mueller at nikisue@throughwithchew.com or at (307) 690-6669.

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Apply to Host the 2010 Summit

The deadline for submitting applications is January 10, 2010.