Speaker Intake Form

Full Name *

Job Title *

Panel *

Best email to reach you *

Address *

Phone Number *

Short bio for promotional use (150 word limit) *0 / 1000

Headshot Upload

Please use the uploader below to share a professional headshot that can be used in GIS promotional materials before submitting this form.

If the headshot uploader does not work, please email your logo file to kcoady@ls2group.com.

Dietary Restrictions, if any *

Is there anyone else (Executive Assistant) we should loop into communications and for scheduling with you? *

Will you bring security with you? *YesNo

Will you bring any additional communication team members with you to the event? *YesNo

Comms Personnel Name *

Comms Personnel Email Address *

Comms Personnel Phone Number *

Do you plan to attend the Speaker-Sponsor Dinner on the evening of April 13? *YesNo