SpeakerRegistration

Speaker Registration

Version 1.9
First Name *
LAst Name *
Cell Phone *
Email *
AddRESS - 1 *
aDDRESS - 2
City *
State *

NC SC
Zip *
Website Release *
Permission to add to the Senior Scholars archives.
Scheduled Dates:
- Presentation & Q&A: Friday 9:30 - 11:30 AM @ Providence United Methodist Church (map), Wolfe Hall; ZOOM presentations can be arranged with Internet connectivity from the speaker's location.
- Cell phone for Tech Support: Gordon Haymond (704) 577-4326.
- The presentation's PowerPoint should be sent to SSaQ's dropbox on Monday; it is used as a backup. It is also shared with meeting moderators. Last minutes changes will be accommodated on the day of the presentation.
- When presenting from a remote location a Technical Check meeting is held on Monday 10 - 11 AM the week of the presentation. It is preferred that this location is used on Friday. If this time is inconvenient it will be rescheduled.
Presentation Date

Month Day Year
Confirm your presentation date
Preparation Date *

Month Day Year
Only needed for ZOOM or remote speaker presentations..
Title
Organization
Presentation Title *
Presentation Description *
Field expands by clicking X in the upper right-hand corner
Biographical Data or Resume *
Field expands by clicking X in the upper right-hand corner
resources for Members: websites and Books (optional).
Field expands by clicking X in the upper right-hand corner
Preferred Photo
A Honorarium is made to the Speaker's charity of choice for $100.

If your organization does not allow a donation:

please enter none for name and address.
Charity Name *
Charity Address *
Street, City and Zip
Charity Email
Include in the Online Senior Scholars Directory

Yes No
The online Member Directory is password protected and only contains name and email address. Phone and address information is not shown.

The directory can not be printed.

The password to access the directory is sent by the membership committee.
Volunteer

Yes No
REc Email

Yes No
LeveL

Speaker New Member
Status
Member Id
2021 Member
Member Until
Method of Payment

Gift check
Update Release

No Yes
Should be Empty:

Speaker Registration

A Honorarium is made to the Speaker's charity of choice for $100.

If your organization does not allow a donation:

please enter none for name and address.

The online Member Directory is password protected and only contains name and email address. Phone and address information is not shown.

The directory can not be printed.

The password to access the directory is sent by the membership committee.