Form3-1  
Information Exchange Seminar Outline FY2016

	Research Field:_______________	
 1) U.S. Coordinator

Name
Title
Affiliation
Contact Details   Tel
		   Email
Short Biographical Sketch
Current Support (please cite participating NIH institute, if applicable).

 2) Seminar Title

 3) Japanese Coordinator

Name
Title
Affiliation 
Address
Contact Details    Tel
Email
Short Biographical Sketch 

 4) Proposed Location and Venue

 5) Proposed Dates, from/to (mm/dd/yyyy)

 6) Content and Purpose of the Seminar including Topics, Names of Speakers, and Tentative Agenda

 7) Proposed Budget