Visionaries - Speaker Sign Up Form
Business Name:
Name:
First Name
Last Name
Phone Number:
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Are you a Chamber Member?
Please Select
Yes
No
What's a Chamber?
How long have you been attending Visionaries Meetings?
Tell us about your business.
Example: We make waffles!
Tell us about what you would like to present about. (Generally 10 minutes)
A donation is required and sponsorships are encouraged to participate as a Visionaries Speaker. All donations go toward our annual fundraiser "Brewathon" to support Honor Flight of Northern New Mexico. Do you agree?
*
Please Select
Yes
No
As a Visionaries speaker, we ask that you attend our leadership meeting prior to your speaking opportunity. Do you agree?
Please Select
Yes
No
Please upload your logo and head shot. (So we can promote your business!)
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