Request for Speaking Engagement

Thank you for your interest in having Intersect Illinois present or speak at your event. Please provide complete and accurate information to ensure your request is processed efficiently

EVENT SUMMARY

About:(Required)

Please provide a summary of the event.

LOGISTICS

Event Host Organization(Required)

Event Contact(Required)

First Name Last Name

Contact Title(Required)

E-mail(Required)

Contact Number(Required)

Event Title(Required)

Date of Event(Required)

Event Start Time(Required)

Participant Arrival Time(Required)

Event End Time(Required)

Location(Required)

Street Address Address Line 2 City State

Link to Event Site (if applicable)

Audience Overview(Required)

Who is the target audience/who will be attending the event? i.e. C-suite level executives within the manufacturing industry. How many people are expected to attend? Any VIPs expected to attend and/or participate?

Speaking Format (panel, fireside chat, keynote):(Required)

If other, what speaking role?(Required)

Length of speaking engagement:(Required)

Who is introducing the participant?(Required)

Is the participant introducing anyone?(Required)

Moderator:(Required)

Will there be other confirmed speakers?(Required)

Yes

Speaking Logistics:(Required)

What's needed for our team to be successful in the presentation? Deck required? Speaking at a podium? Etc.

Will there be a Q&A or audience participation component?(Required)

Yes

Please elaborate:(Required)

SPEAKING DETAILS

What topics/themes would you like covered?(Required)

EVENT SUMMARY

LOGISTICS

SPEAKING DETAILS

Have questions?