NAMIC Online
2017-2018 Call for Speakers
If you are interested in serving as a speaker for NAMIC, please provide some information about yourself.
 Speaker Profile
Please type your name, title & company exactly as you would like it to appear in event materials.
* indicates required field

Speaker Name:

*
First Name
todo Last Name
todo Suffix‡
  ‡ (Jr., Sr., MBA, etc.)
Company Name: *  
Job Title: *  
Badge Name: *  (first name only)  
todo
Address 1: *  
Address 2:
City, State/Province *
 
Zip/Postal Code: *  
Country: *  Preview Badge 
todo
Telephone: * (ex: (xxx) xxx-xxxx)
Fax:
Email:    
Special Needs: We invite all registrants to advise us of any disability and any requests for accommodation to that disability.
Special Needs:
First Time Attendee?
todo

 REGISTRATION FEES
Registration Fees  

 EVENT OPTIONS
How would you prefer to be contacted?
Is your company a NAMIC member?
Are you a PSO participant?
Have you presented at previous NAMIC meetings?
If so, at which meeting, or which month and year?
Have you presented at previous NAMIC-affiliated state association meetings?
If so, for which state association did you present?
In which month or year did you present at a state association?
Have you presented at other conferences, workshops, etc.?
If so, at which conferences or workshops have you presented?
In which month or year did you present at another conference?
Is your session CE accredited?
Please enter a short biography of no more than 80 words.
Please list 3 references with name, company, and phone number.

Reference #1:
Reference #2:
Reference #3:
What is the general topic area of your presentation? Check all that apply.










If 'other,' please list topic(s):
Title of Presentation:
Presentation length:
Desired presentation setting:










Learning Objectives: "At the end of this session, participants will be able to:

Learning Objective 1:
Learning Objective 2:
Learning Objective 3:
Learning Objective 4:
Description of Presentation:
Company Audience (select all that apply):



Individual Audience (select all that apply):









Audiovisual Needs:
Name of Co-Presenter (if applicable):





Registration Policy

If you have registered for an event, you are subject to the terms and conditions of participation at this event as contained in the Event Participation Terms and Conditions found at http://www.namic.org/seminars/terms.asp and will be notified to such by the person completing this registration.