2013 Education Conference - Call for Speakers Survey

Speaker Application for IIA Southern California Education Conference
June 3, 2013 • Sharaton Anaheim Hotel • Wrd4ec.org
** Directions: Please include as much detail as possible in this application. Once we receive all speaker applications we will review them and make the selection. Confirmation will be sent after all applications are reviewed. For any question please contact Jason James: Jason.james@regentsandpark.com

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1. Please provide the following information:

Please provide the following information: First Name
Last Name
Title
Company
Street Address
City
State
Zip

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2. Please provide your contact information:

Please provide your contact information: Telephone No.
Cell Phone No.
email address

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3. Please provide speaker bio.

Please provide speaker bio.

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4. Please select the topic you propose to speak about

Please select the topic you propose to speak about Governance, Risk and Controls

Governance, Risk and Controls - IT

Emerging Issues

Emerging Issues - IT

Government

Government - IT

Compliance

Compliance - IT

Audit Fundamentals

Audit Fundamentals - IT

Industry Specific - Banking/Finance

Industry Specific - Legal

Industry Specific - Retail

Industry Specific - Manufacturing

Industry Specific - Medical

Industry Specific - other

Other (please specify)

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5. Provide your title for your proposed presentation

Provide your title for your proposed presentation

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6. Provide 3 objectives for your proposed presentation

Provide 3 objectives for your proposed presentation

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7. List speaking events you have participated

List speaking events you have participated

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8. Are you a member of IIA?

Are you a member of IIA? Yes

No

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