Speaker Form - California Conference for Women

Speaker Name*

First Last

Short Title*

Organization*

Mailing Address

Please provide a mailing address where we can ship equipment for your session recording, if applicable.

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

What device will you be using for your recording?

This will determine the type of equipment we send to you.

What type of laptop will you be working with?

(i.e. Windows or Mac) - Please indicate model and year with your answer.

What type of iPhone or smartphone do you have?

(i.e. Android, iPhone 8, iPhone X, iPhone 11) Please indicate if you have a cable adapter that can connect your phone to your computer.

Email*

Assistant Email

CC Email

Phone*

Speaker Role*

Please choose your speaker role from list below.

Short Bio*

Please provide a short bio of up to 100 words

Headshot*

Please upload your current headshot to be used on our website, program

Phone

This field is for validation purposes and should be left unchanged.