Thank you for registering for our "Inside Einstein's Universe" Speakers Bureau. The information you provide below will remain confidential and will be used only by members of the "Inside Einstein's Universe" education team. Questions can be directed to All fields are required.

1. Name: (e.g. Dr. Eva Looshon)

2. Institution: (e.g. Milky Way University)

3. Email address: (e.g.

4. Phone: (Optional) (e.g. (555) 555-1234)

5. Location: (e.g. Askme, WY)

6. Topic(s) of Interest/Expertise:

(The Universe Forum is putting together three general presentations that contain great graphics, images, and animations, as well as template pages for you to customize your own personal research.)

Hunting for Black Holes (topics include black holes, x-ray and gamma-ray astronomy)
The Expanding Universe (topics include cosmology, Big Bang, Dark Energy)
Space-Time Telescopes (topics include current and future technology to explore the universe)
Other Topics (please specify):

7. Desired Location:

Please include nearby informal education venues* or institutions in/with which you have
special interest/previous connections and/or distance you are willing to travel:
(e.g. up to 50 miles from Askme, special interest in planetariums, have given several
talks at the Andromeda Science Center, etc.)

8. Level of comfort speaking to a public audience


9. Number of talks you are willing to give: (e.g. one per year, one per month, etc.)

10. Dates you are able/willing to speak: (e.g. Summer 2005, March 15-22, etc.)

11. Additional Comments: (Optional)

*Note: an informal education venue is defined as a non-classroom setting where learning takes
place. Examples include science centers, planetariums, and community groups, such as amateur
astronomy clubs and after-school programs.