Thank you for agreeing to present to our membership and guests. To properly prepare the promotional pieces needed for marketing your presentation, please complete the form and submit the requested information as soon as possible.

If you have any questions, please contact Executive Director Tricia Fusilero for assistance at support@laichicagoregion.org.

Question Title

* 1. Please provide your name as you would like it to appear on promotional materials.

Question Title

* 2. Will you be a presenter or moderator for this program?

Question Title

* 3. Provide your work title as it should appear in promotional materials:

Question Title

* 4. Provide the name of your organization:

Question Title

* 6. Phone Number

Question Title

* 7. Please select a menu type.

Question Title

* 8. Please list any food related allergies or sensitivities or indicate N/A.

Question Title

* 9. What is the date of your program?

Date

Question Title

* 10.  Please upload a short 3-5 sentence bio.

PDF, DOC, DOCX file types only.
Choose File

Question Title

* 11. Please upload your headshot.

PNG, JPG, JPEG file types only.
Choose File

Question Title

* 12. May we share your slides with the event attendees in post-event follow up?

Question Title

* 13. Do you allow yourself to be photographed and for LAI Chicago Region to share your image on the LAI Chicago Region website, social media platforms, and Flickr account?

Question Title

* 14. Please provide the full url to your personal and/or company LinkedIn profile if you give us permission to tag you in a post.

Question Title

* 15. LAI Chicago Region strives to host inclusive, accessible events that enable all individuals, including individuals with disabilities, to engage fully. Please list any accommodation requests here or indicate N/A if no accommodations are needed:

Thank you again. Please feel free to reach out to Tricia Fusilero, Executive Director, with any questions at support@laichicagoregion.org.

T