Conference for Women Speaker Form

Please list your Name, Short Title, and Organization as you would like it documented in conference materials. Your information will be published as written in all conference materials.

Speaker Name*
First Last
Phonetic Pronunciation of Name*
Pronouns
Short Title*
Organization*
Primary Contact Name*
Primary Contact Email*
Secondary Contact Name
Secondary Contact Email
Cell Phone*
* We require direct cell phone numbers for all conference speakers. We will only use this for necessary onsite contact.
Short Bio*
Please provide a short bio of up to 100 words
Headshot*
Please upload your current headshot to be used on our website, program
Max. file size: 20 MB.
Relevant CFW Markets
Select the market specific to your speaker role.
- California
- Massachusetts
- Pennsylvania
- Texas
- National Virtual
Speaker Role*
Please choose your speaker role from list below.
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
Please provide a mailing address where we can ship equipment for your session recording, if applicable.

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

Please provide (3) dates with PST times you would be available to dedicate a maximum of 60 minutes to record this session prior to December 1, 2024. For those with Executive Spotlight Roles to be played at LIVE Conferences, please provide dates to record sessions prior to September 2, 2024 for Texas; October 7, 2024 for Pennsylvania; November 12, 2024 for Massachusetts and January 10, 2025 for California.*

Note: While we can record up until this date, we strongly encourage all speakers to record as early as possible.

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.
Name
This field is for validation purposes and should be left unchanged.