Chapter Speaker Directory Information

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* 1. Would you be willing to be listed on the CMSA website on our Speaker Directory for CMSA Chapter Leaders?

Yes

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* 2. Which topic(s) do you speaker on?

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* 3. Which platform is your preferred method?

In-person

Virtual

I can do both In-person and Virtual

Other (please specify)

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* 4. If you are willing to travel, which regions are you able to travel to?

Northwest

Southwest

Midwest

North East

South East

Hawaii

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* 5. Do you require a honorarium?

Yes

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* 6. If yes, what is your rate?

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* 7. Have you spoken with CMSA before?

Yes

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* 8. If so, which Chapter(s)?

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* 9. Contact Information

Name

Company

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 10. How would you prefer Chapter Leaders to contact you?

Phone

Both

Other (please specify)

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* 11. Contact Photo

Please upload a photo to be displayed in the directory

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File