Speaker Proposal Form

First Name:

Last Name:

Email:

Phone Number:

Organization/Company:

Professional Title/Position:

Company Website:

Professional Bio:

20MB max

Have you presented on this topic before? if so, when and where?

Please upload a professional headshot:

20MB max

Presentation Format:

Please select a format option from the dropdown

Lecture

Panel

Workshop

Interactive Session

Technical Needs:

(A/V, microphones, whiteboards, etc.)

Any additional information the speaker would like us to know:

Session Title:

Session Duration:

30 minutes

1 hour

1.5 hour(s)

2 hour(s)

2.5 hour(s)

Session Description:

Session Learning Objectives:

Do you give us permission to record your session?

Yes No

Do you agree to promote your session on your social media or professional networks?

Yes No

Please confirm that your session will not be a sales pitch or product demo:

Yes, my session is a sales pitch or product demo. No, my session is not a sales pitch or product demo.

Are you expecting compensation for your presentation?

Yes No Open to discussion

If yes, please briefly describe your payment expectations or speaker fee range:

Would you be willing to present for a reduced fee or pro bono in exchange for other benefits?

(e.g., exposure, promotion, event access)

Yes No Maybe – let’s discuss

Do you require travel and/or accommodation reimbursement?

Yes No Not applicable

Please list any additional financial or logistical needs we should be aware of: