Speed Speaker Showcase

Event is 3/20/12 at the University of Utah. Applications subject to review/approval. Participation fee is $300 per speaker.

Credit cards will not be charged until/if application is accepted. 18 speaker maximum.

Name:
Email Address:
Phone Number:
Price Range for Speaking (not to exceed range of $3,000 and not to include travel expenses)	Low $ High $
Showcase Subject Matter:	Please Select Adventure Author Business Comedy Customer Service Diversity Economy Environment Trends Health and Wellness Historian Innovation Leadership Motivation Politics Poverty Productivity Religion Science/Exploration Social Media Teamwork Technology World Affairs
Speaking Credentials, ie: NSA, CSP:
Speaker's Website:
Clients you have spoken for in the last 12 months and may we contact them?	Contact? Yes No Contact? Yes No Contact? Yes No
Will you agree to present within the time frame allocated?	Yes No
Will you agree to maintain your commitment to present regardless of audience size?	Yes No
Questions or Comments: