Panelist Registration Form
Complete this form to become a panelist at the Fifth Annual Secure The Bag Conference on October 19, 2024 in Portsmouth VA.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Number of years in business
*
Industry / Profession:
*
List of your “Professional Titles” for your conference flyer
*
Upload Professional Headshot
*
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Choose a file
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of
Upload Professional Bio
Browse Files
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PANELIST PACKAGES: select one
*
Tier One Panelist Package $300. Personalized event flyer, flyer posted to event website and social media pages, panel participation during the conference, general admission seating.
Tier Two Panelist Package $500. Personalized event flyer, flyer posted to event website and social media pages, panel participation during the conference, VIP seating with swag bag, business cards inside all VIP swag bags, logo on the sponsorship banner.
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