SCEP Speaker/Panelist Request Form

SCEP speaker being requested for the presentation *

About the Requestor

Name of organization *

Website info URL

Requestor Contact Details

Name

Company

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

About the Event

Name of the Event *

Date/ time of the event *

How many minutes would the SCEP participant speak? *

Is the event online or in person?

Online

In Person

What link should be used for participation?

Is this a panel?

Yes

Please provide the professional titles and organization of the other panelists.

Professional Title	Organization
Professional Title	Organization

Target audience of event

What are some specific topics you’d like the participant to cover, or that the audience will want to learn more about?

Is there Q+A?

Yes

What types of questions are anticipated?

Preparation

Would PPT slides be requested?

Yes

Is there a preparation meeting?

Yes

Please provide the timing for a preparation meeting.

Please provide the link for the preparation meeting

Will Press be present?

Yes

What types of press?

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.