2023 Stare Convention Speaker Request for Proposal – form

Name*

First Last

Name of co-presenter (optional)

First Last

Length of Presentation*

30 minutes

60 minutes

30 minutes or 60 minutes

Headshot*

Accepted file types: jpg, jpeg, png, pdf, gif, Max. file size: 64 MB.

Please upload a photo of your face that we can use in our promotional publications, brochures, etc..

Sample Video

Accepted file types: mov, mp4, mpg, mpeg, mp4, Max. file size: 64 MB.

Please record and upload a 2-minute sample video submission or send a link to a recent You-Tube video of you teaching to program @tsrc.org

Highed Educational Credentials*

Highed Professional Credentials*

Home Address*

Street Address Address Line 2 City State ZIP Code

Email*

Enter Email Confirm Email

Home or Cell Phone*

Employment Title*

Place of Employment*

Work Address*

Street Address Address Line 2 City State ZIP Code

Work Phone*

What section best describes the area of interest of this presentation?*

Will you need access to the internet for your presentation?*

Yes

Have you ever presented this information on a state or national level before?*

Yes

Will you be sponsored for travel, hotel, meals or honorarium by an industrial affiliate?*

Yes

If "Yes", who will be sponsoring and describe the sponsorship*

Presentation Title*

List three (3) objectives for your presentation.*

Give a brief, 3-4 sentence summary of this presentation*

Is there any direct or perceived industrial bias within your presentation or on the slide deck?*

Yes

Please submit a brief 3-4 sentence narrative of how you are qualified to present this information*

Please provide a 3-4 sentence introduction to be used if your presentation is selected*

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