Speaker Bio Submission - USED ON SPONSOR PORTAL DO NOT DELETE OR MODIFY

Are you filling this form out for someone else?*

No, I'm the speaker.
Yes, I'm submitting a bio for a speaker other than myself.

Your Name*

First Last

Your Email*

Speaker Information

Name*

First Last

Last Name (for sorting)

I'm speaking at:*

New York 2019

Save to event taxonomy

Company Name*

Job Title*

Email*

Cell*

Shirt Size*

Bio Description*

350 Max Word Count

Photo*

Please upload a high-res, square image that's at least 1000x1000px.

Twitter Handle*

If you're not on Twitter, write N/A

Linkedin*

Please link to your personal LinkedIn profile.

Instagram Handle*

If you're not on Instagram, write N/A

Assistant Name

Assistant Email

Address Type*

USA
International

Mailing Address

Street Address Address Line 2 City State ZIP Code

International Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I identify as*

Check all that apply.

Skills you have at any level*

Choose all that apply.

Agreement

Yes, I have read the Speaker Policy.*

Policy here: bit.ly/SPEAKERPOLICY
Initial here

Yes, I understand that if my company has 100 or more employees, we ask them to purchase a pay-it-forward ticket to support our scholarship fund.*

Please email patty@lesbianswhotech.org if you have any questions. You should receive an email from someone on our team about registration next steps.

Initial here

Yes, I understand my guests have to purchase a ticket.*

Initial here

Yes, I understand I have to hold both Summit dates: September 12 and 13.*

If you have confirmed something with someone on our team, put N/A.

Initial here

Yes, I understand my slides are due by September 4.*

Initial here

Yes, I will do my best to share my speaker graphic and promote #LWTSUMMIT on social media.*

Initial here

Phone

This field is for validation purposes and should be left unchanged.