WIN Presentation Proposal

We at WIN appreciate your interest in presenting to the members of our group. Please complete this form and return your fully completed document to be considered for a speaking presentation.
WIN Presentation Proposal
Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Presentation Title*
Description of your presentation. This will be used for marketing*
Bio*
Reference 1*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Reference 2*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Speaker sheet instead of references/bio:

Upload a File

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Head Shot Photo*

Upload a File

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Event for consideration (check all that apply)

BreakfastLunchKeynote Special Event
Name and contact information o 2-3 people who have heard you speak and can serve as references.
Title*
Company
Cell

Area CodePhone Number
Reference 2
Should be Empty: