Speaker Form

Please make sure to list your name, short title, and company as we will use as written for all conference materials.

Speaker Name*
First Last
Short Title*
Organization*
Email*
Assistant Email
CC Email
Phone*
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
Speaker Role*
Please choose your speaker role from list below.
Recording Equipment Needs*
In order to ensure the highest quality video, we require the following equipment be used during your session recording. Please select below which item(s) you would need for us to send to you.
- Ring light (or other professional quality lighting)
- HD Webcam
- External Microphone
- Ethernet Cable (Speakers should be within 50ft of their router to use an ethernet cable during the recording)
- All of the above.
- None of the above. I have all these items.
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

Please provide 3 dates/times you are available to dedicate a maximum of 60 minutes to record this session prior to January 6, 2023.*

Note: While we can record up until these dates, we strongly encourage all speakers to record as early as possible.

What device will you be using for your recording? i.e. Computer, iPad, iPhone*
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.
Name
This field is for validation purposes and should be left unchanged.