Your Name
*
First Name
Last Name
Title
*
Company
*
E-mail
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
City where you are located
*
Have you previously attended the You Powered Symposium?
*
Yes
No
What speaking position are you applying for?
Keynote (2 available)
Featured (2 available)
Track Host (solo presenter)
Panelist
Moderator
Doctor's Track (must be clinical to apply for this position)
Will you be selecting the members of the panel? If so, please list their names below.
Please describe the topic you would like to cover in your track with an outline of speaking points.
*
Why would you like to take the stage at the You Powered Symposium?
*
Please upload your headshot and bio.
*
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Please upload a sample of any previous speaking engagements, podcast appearances, or slide decks used for our review.
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Will you require reimbursement for travel expenses? (Please note the YOU Powered Symposium has a limited budget for travel expenses and we cannot guarantee reimbursement.)
*
Yes
No
Not sure
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