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
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Last Name (for sorting)
I'm speaking at:*
- Debug 2021
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Company Name*
Job Title*
Email*
Mobile Phone Number
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(HIDDEN) Shirt Size*
Speaker Bio*
Photo*
Please upload a high-res, square image that's at least 500x500px and no larger than 2mb
Accepted file types: jpg, jpeg, png, gif.
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
Best Cell Phone for Day of Logistics*
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(HIDDEN) Address Type
- International
- USA
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(HIDDEN) Mailing Address
Street Address Address Line 2 City State ZIP Code
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(HIDDEN) International Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I identify as*
Check all that apply.
- Woman
- Man
- Non-Binary/Gender-Nonconforming
- Cisgender
- Transgender
- Lesbian
- Gay
- Bisexual
- Queer
- Pansexual
- Ace/Asexual Spectrum
- Black/African-American
- Latino/Latina/Latinx
- Asian
- Indigenous/Native American
- Middle Eastern
- White/Caucasian
- A parent/guardian
- A veteran
- Disabled
- An immigrant or refugee
- Straight (Ally)
- I choose not to disclose.
- Other
Agreement
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Yes, I have read the Speaker Policy.
Policy here: bit.ly/SPEAKERPOLICY
Initial here
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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 michelle@lesbianswhotech.org if you have any questions. You should receive an email from someone on our team about registration next steps.

Initial here
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(Hidden) Yes, I understand my guests have to purchase a ticket.
Initial here
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(Hidden) Yes, I understand I have to hold the Summit dates: April 24th & 25th.
If you have confirmed something with someone on our team, put N/A.

Initial here
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(Hidden) Yes, I understand my slides are due by April 15.
Initial here
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(Hidden) Yes, I will do my best to promote #LWTSUMMIT on social media.
Initial here
Speaker Policy*
- I have read the Speaker Policy.
Speaker Policy here: bit.ly/LWTSPEAKERPOLICY
Summit Dates*
- I understand I have to hold the following Summit dates - December 6th-9th - unless the Lesbians Who Tech & Allies team has already confirmed a time with me.
social*
- Yes, I will do my best to promote #LWTSUMMIT on social media.
privacy*
- Yes, I understand that by speaking at Lesbians Who Tech & Allies I am agreeing that my picture and bio will be listed for this summit and on your website and that future requests to have these removed will not be honored except for extenuating circumstances.
Phone
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Speaker Information

Agreement