**Date of Request:**

**Requested by:** (name/title of requesting official)

**Is this a Strategic Planning Meeting?**

(A laboratory departmental meeting where the purpose is to discuss
strategic planning or critical management issues)

** Yes**

 No

**Sponsoring Office of Science Program and Associate Director or Office
Director with contact information:** (Attach concurrence letter or email
from Associate Director or Office Director)

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**Co-sponsoring Organization:** (title of DOE or DOE contractor
organization or non-DOE entity cosponsoring the conference, if
applicable)

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**Purpose and Objectives:** (Describe in one paragraph, the purpose of
the conference and justify sponsorship of this conference is important
to LBNL's programs and to Office of Science mission).

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**Impact Statement:** (Provide an impact statement of effect if the
conference is not approved.)

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**Conference Chairperson:** (Name, Division and telephone number.)

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**Conference Location:**

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**Rationale for Conference Location:** (Provide a rationale and
justification for site selection; a cost comparison of alternative sites
considered (Attachment 1) and that the site selected is the most
cost-effective considering costs such as travel, per diem, and
conference logistics.

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**ESTIMATED NUMBER OF CONFERENCE ATTENDEES**

[Traveling]{.underline} [Non-traveling]{.underline}

DOE HQ Employees (detail number from each office X X

\[FE, ME, etc.)

DOE Field Employees X X

Contractor Employees (HQ): X X

Contractor Employees (Field): XX XX

LBNL

ANL, etc.

Others (list by category: University, Foreign Visitors, etc.)
[XX]{.underline} [XX]{.underline}

**TOTAL: XXX XXX**

**ESTIMATED DOE/DOE CONTRACTOR TRAVEL, LODGING AND PER DIEM COSTS**

See Attachment 2.

**ESTIMATED CONFERENCE COSTS**

See Attachment 3.

**REQUIRED ATTACHMENTS**

-   Attachment 1: Cost Comparison of Alternative Sites Considered

-   Attachment 2: Estimated DOE/DOE Contractor Travel, Lodging and Per
    Diem Costs

-   Attachment 3: Estimated Conference Costs

-   Attachment 4: DOE Office of Science Conference Sponsorship
    Questionnaire

-   Concurrence from Office of Science Associate Director or Office
    Director

-   Conference Agenda (including duration and any planned activities
    beyond the agenda such as site visits, after hours dinners, etc.)

**SIGNATURE APPROVALS:**

Chairperson:

  -------------------- -------------------------------- ------- -----------
  Signature:                                            Date:   

  Name (Please print                                            
  or type):                                                     
  -------------------- -------------------------------- ------- -----------

Division Director:

  -------------------- -------------------------------- ------- -----------
  Signature:                                            Date:   

  Name (Please print                                            
  or type):                                                     
  -------------------- -------------------------------- ------- -----------

Conference Management:

  -------------------- ---------- -------------- ------------ ----------------
  *Recommendation*:    Approved                  Unapproved   

  -------------------- ---------- -------------- ------------ ----------------

  -------------------- -------------------------------- ------- -----------
  Signature:                                            Date:   

  Name (Please print                                            
  or type):                                                     
  -------------------- -------------------------------- ------- -----------

**LBNL Director/Principal Deputy:**

  -------------------- ---------- -------------- ------------ ----------------
  *Recommendation*:    Approved                  Unapproved   

  -------------------- ---------- -------------- ------------ ----------------

  -------------------- -------------------------------- ------- -----------
  Signature:                                            Date:   

  Name (Please print                                            
  or type):                                                     
  -------------------- -------------------------------- ------- -----------

**DOE BSO Site Manager/Designee:**

  -------------------- ---------- -------------- ------------ ----------------
  *Recommendation*:    Approved                  Unapproved   

  -------------------- ---------- -------------- ------------ ----------------

  -------------------- -------------------------------- ------- -----------
  Signature:                                            Date:   

  Name (Please print                                            
  or type):                                                     
  -------------------- -------------------------------- ------- -----------