Speaker Submission Form

Thank you for serving as a speaker at our symposium. Please use the form below to upload your contact information, speaker bio and headshot. Your information will be displayed in our program book.

Please note that presentation, bio, and photo must be submitted at least 14 days prior to the symposium.

We appreciate your generous donation of time and knowledge!

The CERI Symposium Organization Committee

* Indicates required field

Name *

First

Last

Email *

Business Title *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email address displayed in the program book? *

Yes No

Employer *

Work Phone Number *

Cell Phone Number *

Expertise (up to 5 keywords) *

Paste bio here (200 words max.) *

Upload headshot (300 dpi, CMYK or RGB color, tiff or jpeg format, at least 2" x 2" in size) *

Max file size: 2MB

Presentation will require (check all that apply) *

Internet Use of Powerpoint (email to CERI at least 14 days in advance) Use of Keynote (email to CERI at least 14 days in advance)

Upload presentation (powerpoint, keynote, or pdf) *

Max file size: 20MB

Notes or Comments? *

Validation code - answer this math question to confirm that you are a human: 7 x 2 = ? *

Submit