Speaker Application for Keynotes and Workshops

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Speaker Application for Keynotes and Workshops

Please complete and submit the form below to request Sandy Weiner as a speaker for your upcoming event. Due to scheduling constraints, we typically will not be able to accommodate requests less than 1 month or more than 6 months in advance of an event. Thanks so much for your interest.

Section One
Contact Info
Name*
First Last
Company/Organization*
Title*
Phone Number*
Email Address*
Organization or event website URL*
Section Two
About The Event
Confirmation deadline*
Month
Day
Year
Event Name*
Event Theme*
City*
State*
Country*
Start date of event*
Month
Day
Year
End date of event*
Month
Day
Year
Information about your organization*
How long has the event been in production*
If this is not a first-time event, please provide a list of previous speakers*
Conference/event agenda*
If there is a website with your agenda, enter the URL. Otherwise, paste your full agenda here.
Invited speakers*
Confirmed speakers*
Number of expected attendees*
Audience demographics*
Section Three
About the Opportunity
Requested speech topic:*
Date of speech*
Month
Day
Year
What time will the speech start?*
: Hours
Minutes
AM/PM
What time will the speech end?*
: Hours
Minutes
AM/PM
Is this time slot flexible and/or tentative?*
- Yes
- No
If Yes, please explain below
Format of talk*
- Keynote
- Presentation
- Panel (see below)
- Other (see below)
If Panel, please list other panelists. If Other, please describe format.
Will there be breakout session?*
- Yes
- No
Q&A included?*
- Yes
- No
Name of moderator (if applicable):
Slide presentation required?*
- Yes
- No
- Optional
Are press invited?*
- No
- Yes
If Yes, please provide a list of invited press.
If you answered yes to the question above, is the session on the record?
- Yes
- No
Will the session be recorded?
- Yes
- No
Is there any other information you would like us to know to evaluate this request?

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Speaker Application for Keynotes and Workshops

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