* Indicates required questions
Thank you for considering a representative of the Mobile Technology Association of Michigan to speak at your upcoming event. Please complete the form below to help us learn about your group / company, your event, and to determine your areas of interest so that we may provide the speaker most suited to present on the requested topic. Please note that speaker's may require travel-related expenses to be covered depending on the location / duration of the event and the type of group being addressed.
Name *
Company Name *
Job Title *
Work Phone # *
Mobile Phone # *
Email *
What is the name of the organization / company that is requesting a speaker? *
What is the date / time of the event for which a speaker is required? *
Anticipated audience size *
Type of presentation *
Keynote Breakout Session
What is the EXACT location of the venue where your event will be held (name of venue, street address, city, state, zip)? *
Who will be attending this event (ie: developers, marketers, C-level exec's, small business owners, all members of our company, our clients, job seekers, etc.)? Please give as much descriptive information as possible. *
On what topic are you interested in having us present? *
How much time will be allocated for this presentation? *
Is your organization / firm willing to pay a speaker's honorarium if one is required? *
Is your organization / firm willing to pay a speaker's travel fees (air travel and/or car rental, hotel, meals) if the distance and/or scheduling needs necessitates it? *
Will your organization / firm be able to provide technical support and equipment for the speaker's presentation? *
Yes No
Will you be recording this presentation by audio or video? *
Yes No
Will this presentation be posted online for listening / viewing after the event? *
Yes No
If this presentation will be posted online, will listeners / viewers be charged to hear / view the presentation?
Yes No
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