Naples Interagency Speaker Intake Form
Thank you for your interest in speaking at a Naples Interagency luncheon. Please complete the form below to be considered as a guest speaker. Only Executive Sponsors are automatically confirmed for speaking opportunities. All speakers must complete this form, and all submissions are reviewed and approved by the Naples Interagency Board. Speakers have the opportunity to present at one of our monthly events, hosted on the second Tuesday of each month from 11:30 AM to 1:00 PM. Speaking time is approximately 30 minutes, followed by 15 minutes of Q&A. Absolutely no selling or follow-up selling via email is allowed. NOTE: There is NO fee paid for speaking engagements, nor are speakers permitted to request compensation. Speaking is one of the many benefits included with an Executive Sponsorship.If you’d like to learn more about becoming an Executive Sponsor and the full list of benefits, please visit www.naplesinteragency.com/membershipdetails
Full Name
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First Name
Last Name
Email Address
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example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Title
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Company
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Business Website
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Brief Speaker Bio (100–150 words)
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Proposed Session Title or Topic
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Short Topic Description (2–4 sentences)
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What value will your presentation bring to our senior-focused professional audience?
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Have you presented this topic before?
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Yes
No, first time
Other
Have you presented to NI before?
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Yes
No
Upload Your Professional Headshot (file upload)
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of
Upload Your Company Logo (file upload)
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Choose a file
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of
Preferred Month(s) to Present
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Qtr 1 (Jan, Feb, Mar)
Qtr 2 (Apr, May, Jun)
Qtr 3 (Jul, Aug, Sep)
Qtr 4 (Oct only)
Additional Requirements (AV, accessibility, etc.)
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Are you currently an Executive Sponsor of Naples Interagency?
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Yes
No
Not yet, but I would like to become one
Acknowledgment “I understand that Naples Interagency does not pay speaker fees and that my submission will be reviewed by the Board for approval including Executive Sponsors. My presentation will not be geared towards selling any products to our members and is educational focused only”
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Yes
Signature / Typed Name
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Submit
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