SVN Speaker Bureau Application

Providing responses to the following questions will help the Education Committee understand your interests and expertise to find the best opportunities for you!

Your application will be reviewed by the Education Committee, and you will be notified of placement within 30 days.

Question Title

* 1. Name (credentials, certifications)

Question Title

* 2. Organization

Question Title

* 3. Job Title

Question Title

* 4. Location

Question Title

* 5. Please upload your CV.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 6. Please upload a brief bio.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 7. Please upload a headshot.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Question Title

* 8. Briefly summarize your career and role or experience in the vascular environment (125 words or less).

Question Title

* 9. Describe your speaking experience:

Topics:

Type (local, regional, national, international):

Venue (in-person, virtual):

Audience:

Question Title

* 10. What are your specific research or publication interests, if any?

Question Title

* 11. Please list two references to speak to your speaking experience, including phone number and email address.

Reference 1

Reference 2

Question Title

* 12. Are you interested in having a speaker mentor or co-speaker?

Yes

Question Title

* 13. Can you travel to for speaking opportunities?

Yes