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Speaker Request
Speaker Request Form
Name
(Required)
First
Last
Email
(Required)
Phone
Company Description
(Required)
Company / Organization Name
(Required)
Company/Organization Type
(Required)
Chamber of Commerce
Economic Development Organization
Government Entity
Banking or Financial Services
Legal Services
Hospitality
Technology
Marketing, Advertising or Communications
Speaker Role (for events only)
Keynote
Moderator
Panelist
Presenter
Other
Requested Event/Interview Date
MM slash DD slash YYYY
Requested Event/Interview Time
Expected # of Attendees
(Required)
Approximate Speaking Time & Length
Topic for Event/Discussion/Presentation/Interview
(Required)
Please provide description of the audience profile.
Additional Event Details - In this section, please include a brief description of the event, location (or virtual link), and any other pertinent details.
Comments
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