NAMIC Call for Speakers

* indicates required field

Prefix:

 

Name (Last, First MI):

Professional Designations:

Title:

Company:

Address:

 

City:

State/Province:

Zip/Postal Code:

E-mail:

Telephone:

Fax:

Website Address:


How would you prefer to be contacted?

 

* Is your company a NAMIC Member?

Are you a PSO Participant?


Have you presented at previous NAMIC meetings?

 

month/year?

Which meeting?


Have you presented at previous NAMIC-affiliated state association meetings?

 

month/year?

Which state association?


Have you presented at other conferences, workshops, etc.?

 

month/year?

Which ones?


Is your session CE accredited?

 

Biography (limit to 80 words)


References (3 with name, company and phone)


General topic of presentation?
(select all that apply by holding down the "Ctrl" key on your keyboard)

 

If other, list topics:

Title of Presentation:

Presentation length:

Desired presentation setting?
(select all that apply by holding down the "Ctrl" key on your keyboard)

Learning objectives: "At the end of this session, participants will be able to:

Learning objective 1:

 

Learning objective 2:

Learning objective 3:

Learning objective 4:

Description of Presenation:



Company audience?
(select all that apply by holding down the "Ctrl" key on your keyboard)

 

Individual audience?
(select all that apply by holding down the "Ctrl" key on your keyboard)


Audio/visual needs:

 

Co-presenter:

Co-presenter:

Co-presenter:

Co-presenter:


Please be aware that the information you present to NAMIC may be made available to other associations and organizations who may have an interest in locating speakers and presenters for their seminars and conferences. By submitting your information/presentation you agree that NAMIC may release your information/presentation to any such other associations and organizations and that this decision is within NAMIC's complete discretion and that you release NAMIC and hold them harmless from any and all possible damage or loss from the release of any such information submitted by you.


317.875.5250 - Indianapolis  |  202.628.1558 - Washington, D.C.

NAMIC | Where the future of insurance has its voice TM