2013 Diversity Woman Conference Speaker Agreement

Your Name (required)

Company (required)

Your Email (required)

Your Phone Number (xxx-xxx-xxxx)(required)

Your Proposed Topic

Link to a YouTube or Vimeo Video of you speaking

How did you hear about us (if you have an invite code, enter here)?

Upload your high resolution image here in jpeg format. Please name your image FIRST NAME LAST NAME (JaneSmith.jpg).

Upload your 250 word biography here as a Word document and name the file FIRST NAME LAST NAME (JaneSmith.doc)

By submitting your photo and your biography, you are giving Diversity Woman Media permission to use your image and biography in all promotional materials including print and online related to Diversity Woman magazine and the 2013 Diversity Woman National Business Conference.