Speaker/Presenter Information Sheet

Thank you for accepting our invitation to speak at our upcoming convention on __________________________. Please provide the requested information to assist us in preparation for your presentation and submit this information (6 months out) via email to: (email address), fax (fax number) or mail to (name and address of Program Chair).Name:______________________________________________________________________________________

Lions Club (if a Lions member) :______________________________________District:______________________

Address:_____________________________________________________________________________________

Phone: 1) ______________________________________ 2)___________________________________________

Email: _______________________________________________________________________________________

Title of your presentation/workshop: ____________________________________________________________

This is a

_________Plenary session_____ Workshop/break-out sessionROOM SET UP

Seating style preferred: ___theater ___round tables ___board-room table ___classroom style Podium: ___standing ___standing with light ___table top ____front table ___# of front table chairs

Microphones requested: _____# of wireless lapel mics ___Podium mic ___wireless hand held micAV/Computer: Will you provide your own laptop for your presentation? ________yes/no

If yes, please provide your computer make/model _________________________________

Do you need an internet connection?

________yes/no

Does your computer have WiFI capacity?

________yes/no

Do you need a screen/projector?

________yes/no

Do you need a flip-chart/white board and easel?

________yes/noOther needs: ______________________________________________________________________________

PROMOTIONS

Do you give your consent for the district to include in its promotion of your presentation a link to your personal/business website? ______yes ______noURL of website: ___________________________________________________Signature: ____________________________________________________ Date: ________________________Please provide with this form an electronic version of your resume or a standard promotional press release and an electronic version of your photo.

For Convention Staff Only

Session Date:____________________ Session Time: __________________

# Anticipated: ___________________ Location: _________________________________DA CNV SPIS 06.06.014