Event Speaker Requests

Event Name (required)

Contact Name (required)

Organization (required)

Telephone (required)

Todays Date

Do you have a particular CSCIS member to request?

Email (required)

Event Date (required)

Event Location (required)

Event Address (required)

City (required)

Event Website (required)

Are Travel + Accommodations paid by organizer? (required)
YesNo

Type of Delivery(required)
In PersonWebinarVideo (Zoom/skype)Other

Format (required)
Keynote/PlenaryPresentationPanel

Audience Size

Demographics (Professional Knowledge Level): (required)

Additional Comments (required)

Attach Files