WINCleveland - Speaker Presentation Submission

Speaker Presentation Proposal

Please fully complete this form and submit by October 1 of the current year for next year's programming.
Presenter Name *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
E-mail *
Presentation Title *
Presentation Description (75 words max) *
After presentation, participants will be able to; list three learning objectives: *
Brief Bio: (100 words max) *
List 2 References of people who have heard you speak OR *
If attaching Speaker sheet please type Speaker Sheet in this box
Submit Speaker Sheet instead of references here

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Submit Head Shot *

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Event for Consideration (check all that apply) *

East-side Luncheon Downtown Breakfast Lunch & Learn Keynote Special Event
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Speaker Presentation Proposal