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* 1. Presenter's Name (First, Last)

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* 2. Title

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* 3. Organization/Company Affiliation

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* 4. City, State, Zip Code

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* 5. Email Address

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* 6. PMI Member (Y/N)

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* 7. PMI Certification(s)

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* 8. Speaker's Biography

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* 9. Title of the presentation

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* 10. Please provide a brief overview of your presentation

(Description, 60-90 minutes, learning objectives, etc.)

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* 11. Select the track that best describes your presentation

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* 12. How will your presentation provide value to the audience?

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* 13. Please provide at least two references 

(name/email/relationship, historical speaking event(s) video links)

Both photography and videography will likely be taken on site to document PMICVC events and activities. Photographs and video footage are the sole property of the PMICVC. By submission of this form, you, as a potential speaker, understand that PMICVC may use your likeness for promotional purposes. If you do not wish to be photographed or recorded using audio or video, please notify a board member on site and/or prior to the event.

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