Speaker Form

* Shows Required Fields      

Conference Presenter Application
Presenter's First Name *
Presenter's Last Name *
Certification *
----------------- None PHR SPHR GPHR Ph. D. J.D.
Company Name *
Position Title *
Mailing Street Address *
City *
State *
Is this address your: *
----------------- Work Home
Email Address *
Preferred Phone *
Is this preferred phone your: *
----------------- Cell Work Home
Coordination of Speaking Engagement
Will someone other than yourself be coordinating your speaking engagement? *
Yes No
If someone other than yourself will be coordinating your speaking engagement, please complete the information below:
First Name of Coordinator
Last Name of Coordinator
Position Title for Coordinator
Email Address for Coordinator
Preferred Phone for Coordinator
Presenter's Bio Information & Marketing Resources
This is for marketing purposes only and you do not have to provide this information if you do not wish or do not have accounts.
Do you have a LinkedIn Account?
Yes    No
Please provide a link to your LinkedIn public profile:
Do you have a personal or company website?
Yes    No
Please provide a link to your website:
Do you have a Facebook Fan Page?
Yes    No
Please provide a link to your Facebook Fan page:
Do you have a Twitter account?
Yes    No
Please provide a link to your Twitter page:
Please provide a brief presenter bio (200 words or less): *
Publication Information
If you have authored a book, arrangements can be made with SHRM to have your books available for sale at the program event.
Have you authored content related books? *
Yes    No
Please list the title(s) of the books:
Are you willing to participate in a book signing event?
Yes    No
About the Program
Please Select the Following: *
----------------- I am the only presenter for this program There are two or more presenters for this program
If there are two or more presenters for this program, each presenter MUST complete an application
If there are two or more presenters for this program, please list the names of the additional presenters:
Please enter the event dates that you are able to present this program: (refer to our calendar of events for dates)*
Program Title *
Please provide a program description for HRCI certification (100 words or less):
Please provide a condensed description for printed program and website (25 words or less):
What is the length of the original program? *
Please provide a link for viewing the program (if available):
Has this program ever received HRCI credit? *
Yes    No    Don't Know
What year and month did the program receive HRCI credit
Please provide program number:
Select the type of HRCI credit the program received:
----------------- General Strategic Global
Select Target Audience:*
Introductory - requires little or no previous knowledge of the subject matter Intermediate - requires at least a basic knowledge and some experience Advanced - requires a working knowledge and considerable experience
Select which topic this program is best described as: *
----------------- Diversity Employee and Labor Relations HR Career Development HR Org Development/Training Public Sector HR Risk Management and Safety Strategic Business Management Total Rewards and Compensation Workforce Planning and Employment
Presentation lengths are a minimum of 1.0 hour. Can your program length be adjusted to 1.0 to 1.5 hours?*
Yes    No
Presenter/Program References
Please list the contact information for three individuals we can contact who have seen your program, and/or your presentation skills.
Reference # 1
First Name*
Last Name *
Company Name*
Email Address*
Preferred Phone *
Reference # 2
First Name*
Last Name*
Company Name*
Email Address*
Preferred Phone*
Reference # 3
First Name*
Last Name *
Company Name *
Email Address *
Preferred Phone*
Please list your fee:
Is your fee negotiable?
Yes    No
Please describe payment terms:
Program Presentation Requirements
All speakers will be furnished with a projector, screen and podium with a microphone. If you require additional equipment, please describe below and your contact will discuss the additional arrangements should you be selected.
Please select the audio/visual requirements needed for this program:*
Projector and screen Podium with microphone Flip charts Wireless microphone Tables and chairs for panel Other
If you checked "Other" or need flip charts, please describe:
Do you require any special room arrangements? *
Yes    No
Please describe your special room arrangement needs:
Please share any other pertinent information required to ensure the success of your program:
Presenter Agreements
I understand that by submitting this application that I am agreeing to the following:
I agree to adhere to the deadline schedule furnished by program organizers.*
Yes
I understand that my program presentation is not a showcase for promotion of my business, practice or product, and I will not sell my products or services from the speaker platform.*
Yes
I understand that members of the press may be present during my session.*
Yes
I also understand that I will be notified about the status of my application within 60 days of receipt.*
Yes
I understand that if there are two or more presenter for my program, each presenter MUST complete an application for this program to be considered.*
Yes
Do you have any questions regarding your application? *
Yes    No
Please list your questions here: