REQUEST FOR GUEST LECTURER FORM

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					                                                                                                   Appendix 16

                                          SPECIAL SESSIONS OFFICE
                       REQUEST FOR GUEST LECTURER FORM
                Spring/Summer Session                  Credit Travel Study    Weekend University


Course Name & Number:

Department/Faculty:

Course Instructor:


GUEST

Surname:                                             First Name:                            Initials:

Mailing Address:

Telephone:           Home:                                Work:                      Fax:

UCID or S.I.N. (if first time lecturing at the U of C):

Birthday: (mandatory for first time lecture)


GUEST LECTURE INFORMATION

Date of speaking engagement:

Duration of lecture (hours):

Department Affiliation (if U of C employee):

Honorarium Requested:

Honorarium payable to:                  Individual

If the guest lecturer requests payment to a company, please attach an invoice on company letterhead
which indicates the address the cheque should be sent and a GST Registration Number, or submit a
Small Supplier Certificate Form.


Department Approval                                                          Date:


Special Sessions Approval                                                    Date:


This information is collected under the authority of the Freedom of Information and Protection of Privacy
Act and Statistics Canada. It forms part of your instructor record and is used for payroll purposes. If you
have any questions regarding the collection of this information, please call 220-4990. Your signature
below indicates consent for the collection of this information for the purposes noted above.



Signature of Guest:                                                          Date:



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