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AXS24 (April 28 - May 2, 2024) - Las Vegas - Speaker Proposal Form
Please complete and submit the following information.
*
1.
Proposed speaker information
(Required.)
Speaker Name (First/Last As it would appear in printed materials):
Company:
Title:
Address:
City:
State:
Zip:
Email address:
Phone number:
Cell (optional):
2.
Administrative assistant info (if applicable)
Name:
Phone:
Email:
*
3.
Proposed session title (limit to 75-100 characters)
(Required.)
*
4.
Proposed session description and/or objectives (please provide 3-5 sentences and/or objectives to describe the session, as you would want it to appear in conference materials, limit to 75-100 words)
(Required.)
*
5.
Suggested panelists/ co-presenters (Note: Asembia must approve all proposed panelists. Please limit to 2-3 individuals for panels)
(Required.)
*
6.
Speaker availability (please check all that apply)
(Required.)
Monday April 29, 2024
Tuesday April 30, 2024
Wednesday May 1, 2024
7.
Have you presented this topic at another conference?
Yes
No
If Yes, which conference
8.
If requested, I can present this session more than once during the conference
Yes
No
9.
Speaker Bio (up to 150 words, as it would appear in print)
10.
Additional information, comments, or other suggested topics and/or speakers
