Speakers Application

Speaker Contact Information
Name*
First Last
Title*
Company Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Cell*
Email*
Primary Contact Person
If different than speaker.
First Last
Social Media Links
For tagging you.
LinkedIn:
Twitter Personal:
Twitter Business:
Facebook Personal:
Facebook Business:
Instagram Personal:
Instagram Business:

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Presentation Information
Topics submitted must be educational in nature and not sales pitches or presentations. Thank you for your cooperation.
Presentation Topic or Title:*
Presentation Description:*
Please provide a paragraph (below) for us to use in describing the topic that includes: 1.) Specific marketing issue to be addressed, 2.) What is the significance of this issue? and 3.) What will you offer that will help the attendees handle the issue more effectively?
Please provide 3-5 takeaway points that the audience will learn:*
Our goal is to present information on marketing topics that will enable our members to increase their marketing knowledge.
Will you be able to provide the presentation to the AMA Phoenix so that we can make it available to distribute to the attendees?*
- Yes
- No
Would we be allowed to video tape your presentation for use in efforts to promote our organization, or, to be posted on our website and share with members who could not attend?*
- Yes
- No
Would you like to donate anything for a drawing at our event?*
(optional)
- Yes
- No
Lovely! What would you like to donate as a drawing at our event?*

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Speakers Bio & Company Description
Speaker Headshot*
Please provide a 600 x 600 pixel jpg version of your headshot to use in promotional materials.
Speakers Bio:*
Company Description:*
Company Logo*
Please provide a 180 x 50 pixel white with transparent background png version of your company logo.
Name
This field is for validation purposes and should be left unchanged.

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Speaker Contact Information