Event Speaker Form

Please complete this form to confirm your participation as a speaker at our upcoming events. This will assist our team in guaranteeing a smooth process and position you for success. If you have any questions, please reach out to Marley Whittle at [email protected].

Name(Required)

As you would like to appear in event materials (nametag, agenda, etc.)

First Last

Company/Organization(Required)

Please provide your company/organization name as you would like it to appear on event materials (nametag, agenda, etc.).

Email(Required)

Provide your email address for communication purposes.

Cell Phone Number(Required)

Kindly provide the best day-of contact number in case we need to reach you.

Assistant Name and Contact Information (If Applicable)

Please provide your assistant’s name and contact information only if they need to be included in event communications.

Mailing Address(Required)

This is for our records only and will not be shared.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Bio(Required)

Provide a short biography as you would like it to appear on event materials.

Headshot(Required)

Please include a high-resolution headshot as you would like it to be included in event materials.

Max. file size: 100 MB.

Arrival and Departure Date and Times

Please share your arrival and departure dates and times. This will help us ensure we schedule your in-person mic check in coordination with your travel schedule.

Arrival Date(Required)

Arrival Time(Required)

Departure Date(Required)

Departure Time(Required)

Will you need accommodations at the event hotel?(Required)

Presentation Method(Required)

Please select an option from below to indicate how you plan to share your presentation at the event

Prep Call Availability(Required)

Please include 3 dates and times below that work for a 30-45 minute prep call in advance of the event. These will take place in the two weeks prior to the event. During this call, we will review your presentation, confirm final logistics with you, and provide an opportunity for you to ask any questions you may have.

Description of Presentaion/3 Key Takeaways(Required)

This will help us update the session descriptions. Final presentations should be sent to Marley no later than 2 weeks before the event for the review and editing process.

Reception and Dinner(Required)

Please let us know if you’d like to join us for the reception and dinner on Day 1.

LinkedIn/Website

Share links to your LinkedIn profile or personal/organizational website.