Speaker Interest Form

Are you interested in being a speaker for an upcoming program?

Please fill out the form below for all inquiries.

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First and Last Name

Designations/Credentials (CMP, CMM, CTA etc.)

Company Name

Title

Email Address

Speaker Bio

Are you an MPI Member?

Yes

If yes, to the question above, please give the name of your MPI Chapter affiliated with.

Estimated Speaker Cost

Are you willing to speak complimentary with an in-kind value?

Session Title

Session Description

Learning Objectives: Please list three learning objectives of your proposed session. Learning objectives should be action items for attendees to take away.

Have you presented this session at an MPI Chapter?

Yes

If you answered yes to the previous question list dates and chapter presented to.

Please upload: Bio, resume, previous session recordings, etc.

Any questions or comments for the committee?

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