Conference Speaker Application form

Primary Speaker's Name

First Name Last Name

Company Name as Applicable. If not applicable place a N/A in the box.

City

State

Your Industry *

Your Web Site

Phone Number *

Area Code Phone Number

E-mail *

Confirmation Email example@example.com

The title of your session is the first impression for Conference Attendees. Use a concise, but inclusive, title which clearly conveys what you will be presenting and draws attendees' attention to your topic.

Title of Your Session: *

Category

Category Not Listed

Abstract: Your session abstract will tell Conference Attendees why they should attend your session. To be effective and create interest, it should provide a brief, clear, and concise reflection of your presentation’s content. The abstract should only be one paragraph of between 150 to 250 words in length. *

Outline Your Key Elements. List 4 to 5 primary or key elements of your topic that you will be discussing. *

Please attach a short video of you presenting. It does not have to be on this topic *

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Target Audience *

Have you given this presentation before and/or you do you intend to present it elsewhere in the near future? *

If YES, please list where and when - If NO place N/A in the box. *

Please provide references with phone number or email - If NO place N/A in the box. *

Bio for Speaker # 1 *

Please attach a headshot *

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Speakers Name # 2

Bio for Speaker # 2

Please attach a headshot for speaker 2 *

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Are you both an Exhibitor and a Speaker? In order to schedule your session properly, let us know. *

I agree to submit my presentation prior to the Conference on the IAI powerpoint template *

I understand that my presentation will be made available for attendees to download as a handout after the conference *

I have verfied that all information provided is accurate and complete *

Yes