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Conferences for Women Speaker Form

Please list your Name, Short Title, and Organization exactly as it should appear. This information will be published as written in all Conference materials.

"*" indicates required fields

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User Type

external

internal

Speaker Name*

Prefix First Last

Phonetic Pronunciation of Name*

Pronouns

Short Title*

Organization*

Speaker Cell Phone

* We require direct cell phone numbers for all Conference speakers. We will only use this for necessary onsite contact. Please enter phone number in format 000-000-0000

Primary Contact Name*

Primary Contact Email*

Primary Contact Phone*

Please enter phone number in format 000-000-0000

Secondary Contact Name

Secondary Contact Email

Secondary Contact Phone

Please enter phone number in format 000-000-0000

Bio*

Upload Bio PDF

Paste in Short Bio

Bio upload*

Accepted file types: pdf, Max. file size: 15 MB.

Short Bio*

Please provide a short bio of up to 100 words

Headshot*

Please upload your current headshot to be used on our website and app.

Max. file size: 20 MB.

Relevant CFW Markets*

Select all markets that apply for your speaker role

California

Massachusetts

Pennsylvania

Texas

National Conference (virtual)

CCP/ERG Recording

Speaker Classification*

Sponsor

Board Member

Community Partner

Government Official

In-Kind Sponsor

Media Partner

Non-Sponsor

Speaker Role*

Select all that apply

Keynote Intro/Remarks

Executive Mentor

Moderator

Host

Panelist

Learning Burst

Executive Spotlight Speaker

VIRTUAL – Main Stage

VIRTUAL – Host

VIRTUAL – Executive Spotlight

VIRTUAL – Learning Burst

Podcast

Session*

Select all that apply

Keynote

Breakout 1

Breakout 2

Breakout 3

Learning Stage

Small Group Networking

Wellness Stage

Other

Other Session

Session Time*

Select all that apply

8:45am – 9:45am

10:15am – 1:15pm

1:45pm – 2:45pm

3:15pm – 4:15pm

Other

Other Session time*

Contract Commitments*

Select all that apply

Book Signing

Highlight Reel

Meet & Greet

Media Interview

Newsletter Interview

Nat’l Conf Keynote Replay

Nat’l Conf Live Q&A

Podcast Recording

Podcast Replay

Social Media Post

Sponsor Breakfast

N/A

Book Title

If speaker has authored a book, please provide the title(s).

Contract*

Max. file size: 20 MB.

W-9 (Tax Form)*

Max. file size: 20 MB.

Total Fee*

Honorarium*

Total Fee (dollar amount only)

Travel Stipend Amount*

dollar amount only

Deposit Amount*

dollar amount only

Deposit Due Date*

Month

Day

Year

Deposit Invoice*

Max. file size: 20 MB.

Balance Amount

dollar amount only

Balance Due Date

Month

Day

Year

Balance Invoice

Max. file size: 20 MB.

Additional Information

ex. Moderator Assignments, Payment Details, Rider Requirements, Green Room Requests, Security, Hair & Makeup, etc.

Will you be attending one of our 4 live conferences?*

Texas

Pennsylvania

Massachusetts

California

N/A

Would you like to be filmed with our professional film crew on site?

Yes

No, I’d prefer to record myself virtually”

Recording Information

Please identify 3-4 dates/times that you are available to dedicate a maximum of 60 minutes to record this session between October 7th and November 8th, 2024. We will work with the producer's calendar to select one time for recording. Calendar invite to follow.*

Please identify 2-3 dates/times you are available for a 30 min prep call at least a week prior to your recording availability. This prep call will be with you and the CFW Program Director. Calendar invite to follow.*

Recording Equipment Needs*

In order to ensure the highest quality video, we require the following equipment be used during your session recording. Please select below which item(s) you would need for us to send to you.

Ring light (or other professional quality lighting)

Ethernet Cable (Speakers should be within 50ft of their router to use an ethernet cable during the recording)

All of the above.

None of the above. I have all these items.

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

What device will you be using for your recording? i.e. Computer, iPad, iPhone

This will determine the type of equipment we send to you.

What type of laptop will you be working with?

(i.e. Windows or Mac) – Please indicate model and year with your answer.

What type of iPhone or smartphone do you have?

(i.e. Android, iPhone 8, iPhone X, iPhone 11) Please indicate if you have a cable adapter that can connect your phone to your computer.

Form Submitted by*

Name

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