National CFW Virtual Speaker Form - The Conferences for Women

Speaker Name*

First Last

Phonetic Pronunciation of Name

Pronouns

Short Title*

Organization*

Email*

Assistant Email

CC Email

Cell Phone*

*We require direct cell phone numbers for all conference speakers. We will only use this for necessary 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.

Speaker Role*

Please choose your speaker role from list below.

Topics*

Please select your top (3) topic preferences from the 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 15, 2023.*

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.

Phone

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