Speaker Bureau Submission Form

This Speaker Bureau Submission Form is a centralized online submission platform that is shared among numerous professional healthcare associations who are all seeking qualified, professional, knowledgeable speakers to share information with their members for purposes of continuing education. 

By completing the online form below, you can let one or more of these associations know that you are interested in conducting a presentation either face-to-face (traditional meeting) or virtual (audio conference/webinar) meeting.

If you have any questions, please contact us by email or call 888.391.0977.


Instructions:  Please complete the online application for each presentation title.

About You

*First Name

*Last Name

Credentials

Employer

Title

*Address

Address

*City

*State

*Zip

*Work Phone

Cell Phone

*Email

Website

*Bio

This is a brief narrative biography for each presenter. It will be used to introduce the presenter(s) during the presentation, and may be included in marketing materials.

Photo - please email a photo (optional).


About Your Presentation

*Title

 

*Topic Area

 

*Description

This is a brief 25-50 word description of presentation. This description will be used in the marketing material.

 

*Preferred Presentation Setting

 

*Preferred Speaking Time of Day

 

Preferred Associations

Select one or more healthcare associations that you would like to apply to speak.

*Length of Presentation

Additional Speakers

Speaker First Name Last Name Email
#2
#3
#4
#5

Fees

Please indicate your fees below. 
The determination of compensation will be decided by the applicable association.

*Speaking Fee

My Honorarium Fee Is: $

Other Fees:  $
 

*Travel

 

Total Travel Fee:  $


Audio Visual Equipment

The association will provide an LCD projector and a microphone. 

The speaker must provide his/her own laptop.

Please indicate any additional AV requests that you may have.  However, the fulfillment of the request is not guaranteed and will be determined by the applicable association.


Handouts

All speakers should prepare a handout for their presentation.  Handouts must be submitted to the association by the date instructed and should be in electronic format. 

If the speaker is unable to submit the handouts by the deadline date, he/she may be responsible informing the association and for the reproduction, shipping, and costs associated with making the handouts available.   Please note that the association does not assume financial responsibility for development of the presentation.

The length should not exceed 45 slides or 15 pages per hour of program content. Do not use more than 8 lines of text on each PowerPoint slide so they can be read when printed.  

Provide both the original PowerPoint file (ppt) and/or Microsoft Word document.

All handouts must be converted to Acrobat Reader (PDF) documents.  To download a free PDF converter, visit www.primopdf.com and download PrimoPDF

For PowerPoint presentations, the Acrobat Reader (PDF) document should be printed in pure black and white in the handouts view with 3 slides per page with notes (learn more).   Please review your slides to confirm that your handouts can be read in the 3-per-page handout format. 

Do not include advertisements for the speaker's organization or business, products or services.


Speaker Agreement

I have reviewed and acknowledge acceptance of the Speaker Agreement.

*  


Comments

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