CPAO Presenter Form

CPAO Presenter Form

CPAO Presenter Form
- Name of Presenter:*
- Company or Organization:*
- Phone Number*
  Please enter a valid phone number.
- Email*
  
  Confirmation Emailexample@example.com
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Do you have a website? Please enter the URL below:
- Direct Payment Fees To: (if different from address above)
- Session Title:*
- Session Description: (for use in conference brochure)*
- Session Date:
  
  MonthDayYear
  Date
- Session Time:
  
  MonthDayYear
  Date
- Materials: (will you have handouts, PowerPoint, etc.?)
- Presenter Bio: (limit to 300 words)
- Please attach an image of presenter when submitting this form.
  
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- AV EQUIPMENT
  
  We will have a screen, podium and projector in each room.
- Let us know if you need anything else:
- ACCOMMODATIONS AND FOOD:
- Please let us know your need for accommodations and food: (if you prefer not to stay at the resort, the nearest hotels are: The Hotel Salem and the Best Western Mill Creek*
- I have reviewed this Presenter Confirmation, completed the blank sections and agree with all information contained herein and by my signature below I agree to the terms, conditions and arrangements listed.
- Type or sign your signature*
- Should be Empty: