League Event Speaker Registration Form

LEAGUE EDUCATION SERVICES

NEW SPEAKER REGISTRATION
Complete the form below to be considered as a speaker for the California Credit Union League

CONTACT INFORMATION
First Name:
Last Name:
Company:
Title:
Address1:
Address2:
City:
State and ZipCode:
Phone Number:
FAX Number:
E-mail Address:

PREVIOUS SPEAKING EXPERIENCE
At what size audience are you comfortable speaking? (select all that apply)		10-50 50-100 100-200 200+
Organization #1:
Contact #1:
Telephone #1:
Organization #2:
Contact #2:
Telephone #2:
Organization #3:
Contact #3:
Telephone #3:
Biography:
Speaking Topics:
Please check the materials you will be sending:		Video of speech Outline of speech topics Letters of reference

ADDITIONAL INFORMATION
What is your speaking fee?
Will you speak without an honorarium?		Yes No
Will you absorb your travel and related expenses?		Yes No
If not, are you willing to travel on a restricted air ticket?		Yes No
From where are you traveling?
Do you agree not to sell or promote your company's products during the session?		Yes No
What audio/visual equipment do you usually require?

CONTACT PERSON OTHER THAN YOURSELF
Name:
Address:
City:
State and ZipCode:
Phone Number:
FAX Number:
E-mail Address:


Please send your materials under separate cover to: New Speaker Registration, Attn: Diane Spiegel California Credit Union League P.O. Box 3000 Rancho Cucamonga, CA 91729

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