A Community of Professional Speakers

The St. Louis Chapter of the National Speakers Association

Program Submission Form

"*" indicates required fields

Name*

First Last

Special Designations - i.e. CSP, CPAE, etc.*

Cell Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Website*

Month and Year of your presentation*

Program Title*

Program Description - Please copy and paste your program description here, OR indicate you have uploaded a document with your program description below.*

Speaker Bio - Please copy and paste your bio here, OR indicate you have uploaded a document with your bio below.*

Link to Promo Video you would like us to include (Optional)

Do you have any AV/Tech requirements? If yes, please upload a sheet with the details or write your requirements under Additional Details below.*

Yes

The chapter will be treating you to dinner on Thursday and ordering lunch on Friday. Do you have any special dietary needs or restrictions we should know about?*

How would you like us to pay your honorarium?*

PayPal

Check

If you would like to be paid via PayPal, please indicate the email you use for your PayPal account. If you chose the check option, please indicate who we should make the check out to. Your check will be mailed, unless you request it be presented to you at the meeting on this form.*

Additional Details: Please use this space to describe any additional details or program needs.

Upload Headshot*

Drop files here or

Max. file size: 256 MB.

Upload Program Description

Max. file size: 256 MB.

Upload Speaker Bio

Max. file size: 256 MB.

Upload AV/Tech requirements

Max. file size: 256 MB.