Speakers Bureau Referral Form

Thank you for your interest in joining the NOACC Speakers Bureau. To be considered as a potential speaker for our member Chambers of Commerce for their luncheons, annual meetings or other events, please complete the following survey with accurate and detailed information.

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* 1. Please provide the following contact information:

Full Name

Company/Organization

Position/Title

Address

City

State

ZIP

Email Address

Phone Number

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* 2. Brief Bio (100-150 words): You may upload your full bio at the end

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* 3. Areas of Expertise (Select all that apply):

Business Strategy

Marketing and Sales

Leadership and Management

Technology and Innovation

Finance and Accounting

Legal and Compliance

Human Resources

Other (please specify)

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* 4. Do you have previous speaking experience?

Yes

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* 5. If Yes, please list up to three recent speaking engagements (including event name, date and topic):

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* 6. Do you require any special equipment or setup for your presentation?

Yes

If yes, please specify

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* 7. Why do you want to join our Speakers Bureau? (50-100 words):

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* 8. Is there anything else you would like for us to know about you or your presentations?

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* 9. Please provide contact information for at least two professional references who can speak to your expertise and experience as a presenter:

Reference 1 Name:

Reference 1 Contact Information:

Reference 2 Name:

Reference 2 Contact Information:

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* 10. Bio Upload

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

Choose File

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* 11. Headshot Upload

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

Choose File

Thank you for submitting this form. It will be submitted to the NOACC Programming Project Team for review and then , if approved, added to the Speakers Bureau, which is a benefit available only to NOACC Chambers.