Full Name
*
First Name
Last Name
Phonetic Spelling of Full Name
*
Company/Organization
*
Professional Title
*
If you are an employee, please include your job title.
Email
*
Phone Number
*
Of marketing contact
Brief Professional Biography
*
For promotional purposes
High-resolution Headshot
*
Browse Files
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Choose a file
jpeg / png accepted
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of
Company logo - suitable for placement on a white background
*
Browse Files
Drag and drop files here
Choose a file
jpeg / png accepted
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of
Preferred LinkedIn URL
*
Preferred Instagram Handle
Which day of the conference are you participating in?
*
Feb 25: Black Entrepreneurs Day
Feb 26: Black Leaders Day
Feb 27: Black Changemakers Day
What type of session are you participating in?
*
Keynote
Panel Lead
Panelist
Workshop Facilitator
Entertainment
What would you like the title of your keynote session to be?
What is the focus of your keynote session?
Will you be utilizing a presentation or visual elements for your keynote?
Yes
No
Not Sure
Will your presentation require audio?
Yes
No
Not Sure
I authorize the Black Talent Initiative to use the assets provided on behalf of my organization, including any photographs, videos, or voice recordings captured concerning the organization/company, for promotional and presentation purposes.
*
I agree
I do not agree
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