Speaker Proposal Form Speak Request Form Name Title Company or Organization Contact Phone Number Email Company Facebook URL (if applicable) Company Twitter Handle (if applicable) Company Instagram Handle (if applicable) Area of Expertise/TopicTitle of Presentation Target Audience Can you tailor your presentation to last 45 minutes or less?YesNoA/V Requirements Screen Projector Microphone Laptop Pointer Internet Access None Top Three Takeaways (What practical tips, guidance, and outcomes will attendees be able to implement by attending?)Speaker Bio (Highlight relevant features of your career, experience and/or education, as well as your experience as a speaker. It should not describe company products or services. Include any website and/or article links.)Proposed PR Blurb (Provide a short blurb that may be used on the website and in other pre-event publicity.)Speaker Photo (This may be used on the website and in other publicity.)Max. file size: 30 MB.CAPTCHA