Speaker Invitation

Name

First

Last

Professional Title

Credentials

Company

Website

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Please provide a short biography highlighting experience and information that is relevant to your topic

highlighting you Presentation

Who referred you to possibly speak at our conference?

Presentation Title

Please provide a title for your presentation. Clever titles are encouraged.

Presentation Abstract

Please provide a brief description of your proposed presentation.

Acknowledgment

By completing this form, you acknowledge that no additional expenses will be charged to Chesapeake Region Safety Council for speaking fees, accommodations, food, or any other materials for breakout sessions.

For questions regarding speaker opportunities, please reach out to christy@chesapeakesc.org.