NCWIN Speaker Sign Up

- Full Name*
  
  First NameLast Name
- Business Name*
- E-mail*
- Website
- Your Best Contact Phone Number*
  
  Area CodePhone Number
- Your Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- How did you learn about NCWIN?*
- Have you ever attended an NCWIN event?*
  
  YesNo
- Have you ever been a member of NCWIN?*
  
  YesNo
- Have you ever spoken at NCWIN?*
  
  YesNo
- Date and topic of last time you spoke at NCWIN*
  Type "N/A" if you have never spoken at an NCWIN event
- Which category does your topic fit into?*
  
  Business EnhancementPersonal DevelopmentHealth & WellnessOther
- Title of Your Presentation*
- In 3-4 sentences describe your presentation*
- IMPORTANT: Your application will not be reviewed if you do not write 3-4 sentences that can be used to describe to our audience the content and value of your presentation. This will be copied and pasted directly to our website and email announcements. Check for spelling and grammatical errors before submitting.
- With 3-4 bullet points, list the benefits or outcomes of your presentation*
- IMPORTANT: Your application will not be reviewed if you do not write 3-4 bullet points unique from the "presentation description" that will highlight the key takeaways of your presentation. This will be copied and pasted directly to our website and email announcements. Check for spelling and grammatical errors before submitting.
- Will you need to connect to a TV screen for your presentation? (if you check yes, please bring your laptop and HDMI cable)*
  
  YesNo
- Description of item you are providing for our door prize drawing including the value of the item
- Upload picture of yourself to be featured on our website*
  
  Upload a File
  This headshot looks best when it shows more of your face and less of your body. Please crop accordingly. Cancelof
- Upload your bio*
  
  Upload a File
  
  Cancelof
- How would you like to be introduced?*
  Please give us a 2-4 sentence intro that we will read when you are introduced.
- Are a published author?*
  
  YesNo
- If "yes", please list your book titles here:*
  Type "N/A" if you are not a published author
- References*
- Please list any events in San Diego that you have spoken at in the past 12 months.*
- Should be Empty: