Custom Event Speaker Form

As part of your sponsorship agreement, you are entitled to host a Virtual Speaker Event for your organization. The event must take place before June 30, 2023, otherwise the opportunity expires. The format for the event is as follows:

* Event not to exceed 60 minutes;
* Speaker to present remarks for 25-30 minutes*;
* Q&A for 25 minutes (Note: the Q&A can be facilitated with a moderator that you provide or you can choose to provide an executive from your organization to interview the speaker).

In order for the Conference Team to confirm a speaker, please complete and submit the form below within 10 business days. If the form is not returned within this timeframe, the Conference Team cannot guarantee that we are able to fulfill your request. Additionally, we are not able to start the booking process if the form is not filled out in its entirety. Thank you for your cooperation and your continued partnership.

If you have any questions, please contact Rachael Lange at [email protected].

*Click HERE to review SPEAKER OPTIONS . If a speaker is listed as “In Conversation Only” the entire session will be a Fireside Chat where you provide a moderator.
Organization*
Contact*
Email*
Telephone*
Preferred Date/Time Options:*
Please provide 3 options that work in order of preference to hold your event.
Technology Platform:*
Please share which platform you plan to use to hold the event (i.e. Zoom, WebEx, etc.).
Audience Size and Demographics:*
Please be specific in terms of who will be in attendance including gender, job functions/levels, etc.
Speaker Books:
If the Speaker has books, are you interested in buying copies for your employees or group?

Yes

No
Speaker & Topic Choices:*
*PLEASE REVIEW SPEAKER OPTIONS HERE . Use the space below to list 3-5 speakers in order of preference that you would like to host and the topics you would like them to speak on. NOTE: a minimum of 3 speakers must be listed for our team to start the invitation process.