Speaker/Presentation Application

Tribal Leaders Summit & Trade Show
Prefix:
First Name:
Last Name:
Primary Contact (If other than you):
Telephone:
Email:
Organization:
Address:
City:
State:
ZIP:
Brief biographical sketch (100 words or less):
Title of the presentation as you suggest it be published (10 words or less):
List the top three to five (3-5) learning objectives of your presentation:
I am a(n):
Select Track:
Please indicate if your organization is interested in being an exhibitor or sponsor:

In submitting this proposal, I certify that I am available for the date(s) designated above. I understand that I will not receive a speaking fee for the presentation(s) and will be required to register to attend the conference. If selected, I agree to abide by the deadlines and other conditions of presenting. I understand that my conference presentation is not a showcase for promoting my business, practice or product, and I will not sell my products or services from the speaker platform. I understand I will provide summary updates or blog material prior to the conference for marketing materials.

I have read and understand the statement above.