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IDEA eBiz Forum 2016 Speaker Application

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Please provide the following contact information (complete all fields):

Name:

Job Title:

Company:

Mailing Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Email Address:

Phone Number:

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Please provide the following emergency contact information (complete all fields):

Emergency Contact Name:

Relationship:

Phone Number:

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Date(s) available to present:

5/25 - Wednesday

5/26 - Thursday

5/27 - Friday

Available all days

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General topic(s):

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Target audience(s):

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Please provide an abstract of your proposed session or sessions (description and objectives):

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Please be advised that photographs and video will be taken at the event for use by IDEA in various media including, but not limited to: the IDEA website, press releases, marketing materials, and publications. I unders and that applying to speak at this event means I give consent for IDEA to photograph, film and use my image and likeness.

By providing my electronic signature below, I am indicating that I understand that applying to speak for this event also means that I give consent for IDEA to distribute my speaker presentation to all eBiz Forum attendees and also make it available to download on the eBiz Forum website.