Call for Speakers

Required fields are displayed in bold text.

Personal Information:

First Name:

Last Name:

Title:

Company:

Email Address:

Phone Number:

Mobile Number:

Address:

City:

State/Province:

Postal Code:

Country:

Are you currently a member of the following association?

AFSMI No, I am not currently a member

I have an administrative assistant that I wish for you to contact: Yes No

I have a Co-Speaker(s): Yes No

Administrative Assistant Contact Information:

Contact Name:

Contact Title:

Contact Company:

Contact Email:

Contact Phone:

Contact Address:

Contact City:

Contact State/Province:

Contact Postal Code:

Contact Country:

Presentation Title:

I'm submitting this presentation to be considered as a:
Select the type(s) of presentations you wish to be considered for
Keynote Session
Break-Out Session
Workshop Session
Panel Discussion
Partner Session

Learning Objectives: (please provide all 3 learning objectives for your presentation)

Presentation Abstract: (200 words or less)

Speaker Biography: (100 words or less)

Previous Speaking Engagements: (inlude date, event name, and presentation title)