Speaker Collateral

Name

First Name

Last Name

Preferred Title/Role

Preferred Pronouns

Email

Phone

(###)

###

####

Social Media Handles

Instagram, Facebook, etc

Short Bio (300 Words Max)

Final Presentation/Workshop/Speech/etc Title

Final Presentation/Workshop/Speech/etc Description (200 words max)

Notes About Room Setup/Other Presentation Needs

Enter N/A if none.

Dietary Restrictions/Allergies

Enter N/A for none

Honorarium and Travel Reimbursement Donation

Yes, I wish to donate my honorarium back into the summit.

Yes, I wish to donate my travel reimbursement back into the summit.