Speaker Opportunities

Speaker Information

First Name: *

Last Name: *

Designation:

Job Title:

Company/Organization:

Address:

City:

State/Province:

Country/Region:

ZIP/Postal Code:

Primary Phone:

E-Mail Address: *

Additional Presenters Information

First Name:

Last Name:

Designation:

Job Title:

Company/Organization:

Email Address:

Contact Information (if submitting someone else as a speaker)

First Name:

Last Name:

Designation:

Title:

Company/Organziation:

Email Address:

To submit a speaker proposal, instead of or in addition to the submission form provided here, the document must include information from each of the categories below. Copy and paste in the field below.

Speaker Proposal:

For which event are you interested in speaking/submitting a speaker?:

Session Title:

Presentation Summary: (Write a 50-75 word summary of the presentation. Be sure to include all major points of the presentation and do not refer to presenters by name)

Presenter Biography: (Provide a short biography of presenter(s). No more than 50 words)

Qualifications: (Briefly describe your qualifications to present the material. List past Event Name, Presentation Title and Date Presented and include several references, names, titles, phone numbers)

Primary Topic:

Secondary Topic:

Target Audience:

Industry:

Property & Casualty

Life & Health

Insurance Fraud

Other (please list)