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From: (your email here)
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Subject
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Conference Speaker Info
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Your Full Name:
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(as it should appear in brochures and conference promotion)
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Current Job Title:
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Degrees/Professional Designations: (ex: DVM, PhD, MS)
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Conference Name:
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Alpaca Conference (July 26, 2008)
J.T.V. Equine Conference (October 17-18, 2008)
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I am:
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an internal speaker
an external speaker
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Lecture Title(s):
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Please list all lecture titles above. One per line please.
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Speaker Biography (Brief Bio Only Please)
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Please cut and paste your bio or type it here. This information will be used by the moderator to introduce speakers at larger conferences.
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Audio/Visual Needs:
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Laptops, microphones, projectors, and screens are provided in all meeting rooms.
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Address:
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(no PO Boxes please)
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City:
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State: (2-letter code)
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Zip Code
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Primary Phone:
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Cell/Mobile Phone:
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Alternate Phone:
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Fax:
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Email:
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Hotel Needs:
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Yes, I need one room.
No, I do not need a room.
(external speakers only)
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I prefer:
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a non-smoking room
a smoking room
not applicable
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Arrival Date:
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(for external speakers only)
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I will depart:
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(for external speakers only)
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Special requests or needs:
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If you have special needs or are requesting that we reserve more than one room in your name, please delete this text and describe your situation here.
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I am an internal speaker and wish to be paid via:
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Not Applicable (I am an external speaker)
My Discretionary Teaching Account (not taxable)
Private Payment (taxable/reported to IRS)
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