CLE Course and Speaker Request Form
Name
*
Email
*
example@example.com
Organization/State Bar
*
Position
*
How did you hear about us?
*
Please Select
Referral
Saw an ad
Search engine
Social media
Email
Event Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Is this event on-site or virtual? (If onsite, where?)
*
If on-site, will some or all of the speaker’s travel expenses be reimbursed?
Requested Topic
*
Requested Duration
*
Please Select
60 minutes
90 minutes
Two hours
More than two hours
Number of Attendees
*
Will this event be recorded or livestreamed?
*
None
Recorded
Livestreamed
Will you charge a registration fee for this event?
Yes
No
Who is the audience?
*
How will you promote this event?
Do you agree to distribute the ALPS-branded marketing assets that will be provided for this program in your marketing and to your attendees?
*
Yes
No
Can ALPS promote this event on our social media?
Yes
No
Additional information
Please verify that you are human
*
Submit
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