2021 Speaker Intake FormYour information What is your name and title? This is what will appear on webpages, print, and how we will introduce you. How is your name pronounced? What pronouns do you use? Please write your bio. This will be used on webpages, print, and during your introduction. Anything else for us to include while introducing you that shouldn't be included in print promotions? Please upload your headshot: Or let us know that you've emailed your headshot already :I've already emailed my headshotI haven't emailed it yet but I'm doing it right now! We will be recording this virtual event and it may be posted on our website, shared as resources, or used as social media and promotion. I understand and am fine with my photo/video being used for the above reasonsI understand and would like to opt out of my photo/video being usedIssuing payment In order to issue payment, we need your completed W9. Find a fillable PDF W9 and upload your completed W9 below: Your telephone number: Your email address: The address the check should be mailed to (if different than what's listed on your W9). Contact Information
