PRS Speaker Form

Speaker Name *
Please Run the Wizard
Topic(s) *
I preferred to be contacted by: *

Office Phone Cell Phone Email
My office contact person:
Office phone number *
Cell phone number (for emergency onsite contact only) *
Email *
Mailing address *
Please provide your name as it will appear in the program brochure. If applicable, please include professional title(s) and position(s) *
Complete your Photo/Video Release Now
Upload your photo/video release form. *
Complete your CME Speaker Disclosure Now
Upload your biography (not CV). Maximum word count of 300. *
Upload your head shot to be used for meeting marketing.
Spouse/Guest
Terms & Conditions

The Carnell Russ Foundation - Community Unity Festival
I agree to have my presentation submitted by Friday, September 6, 2019. If I do not feel I will be able to meet this deadline I will contact The Carnell Russ Foundation staff as soon as possible to coordinate late submission. I also understand that if I have not submitted my presentation by Friday, September 13, handouts for my topic/promotions) may not be provided to attendees. *

I agree to the terms outlined above.
If I am unable to present, I will make a "best attempt" to find a comparable replacement and will notify The Carnell Russ Foundation immediately upon discovering a conflict with my presentation date or time. *

I agree to the terms outlined here.
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Terms & Conditions