General Interest - Speaker Proposal Form

Primary Speaker's Contact Information

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1. First Name: (Required.)

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2. Last Name: (Required.)

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3. Title:

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4. Company/Organization Name:

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5. Daytime Phone Number:

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6. Cell Phone Number:

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7. E-mail Address: (Required.)

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8. I am a:

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9. Biography (brief) (Required.)

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10. I would like to be considered for (select all that apply):

Spring Conference - Keynote Speaker

Spring Conference - Session Speaker

Legislative Conference - Session Speaker

Educational Program (Before a Networking Event)

Monthly Membership Meeting (live via Zoom w/recording) – Professional Development

Monthly Membership Meeting (live via Zoom w/recording) – Personal Development

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11. Speaker Honorarium

Compensation is required

Compensation is optional

Compensation not needed/No compensation accepted

Other (please specify)

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* 1. First Name: (Required.)

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* 2. Last Name: (Required.)

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* 3. Title:

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* 4. Company/Organization Name:

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* 5. Daytime Phone Number:

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* 6. Cell Phone Number:

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* 7. E-mail Address: (Required.)

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* 8. I am a:

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* 9. Biography (brief) (Required.)

Question Title

* 10. I would like to be considered for (select all that apply):

Question Title

* 11. Speaker Honorarium

1. First Name: (Required.)

2. Last Name: (Required.)

3. Title:

4. Company/Organization Name:

5. Daytime Phone Number:

6. Cell Phone Number:

7. E-mail Address: (Required.)

8. I am a:

9. Biography (brief) (Required.)

10. I would like to be considered for (select all that apply):

11. Speaker Honorarium