Speaking Opportunities

Personal Information

Presentation Details

Please provide a short and compelling presentation title in 5 words or less.

Captivate the audience and thoroughly describe what will be covered in your presentation.

List any interactive exercise you may do with the audience.

What are the learning outcomes?

What is your preferred method of delivery?

Do you require any special equipment or support?

Experience & Qualifications

List any past presentations or public speaking engagements.

Agreement & Consent

Release of Presentation Materials

Copyright Permission

By submitting this form, I warrant that all of the material that I provide for program handouts is my own original work; that is does not violate any copyright or other proprietary rights of others; that it is factually accurate and contains no libelous matter; and that I assign PMI Michiana the copyright therein for purposes of distributing the handouts and posting them on the internet. This copyright assignment will specifically not prevent you for presenting or publishing the same material or using portions thereof as you choose.

Internet Waiver and Authorization

By submitting this form, I do hereby authorize PMI Michiana to make available on the PMI Michiana website, the handouts and/or presentation I provide for the above-named session.

Recording Waiver and Authorization

Do You Agree to Follow PMI's Speaker Guidelines?

Do You Consent to Having Your Presentation Recorded and Shared?

Additional Comments or Questions