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Speaker / Content Release Agreement
We look forward to hosting you at our Financial Health Network event. Please complete the information below.
OK
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Title
(Required.)
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4.
Company
(Required.)
*
5.
Email
(Required.)
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6.
Phone Number
Your phone number will ONLY be used to coordinate logistics, and NOT for marketing or promotions.
(Required.)
7.
Which speaking engagement are you participating in?
Virtual Event
Article / Blog
In Person
8.
Assistant Name
9.
Assistant Contact Information (Phone Number and Email)
*
10.
I certify that the information provided in this form is true, accurate, and complete to the best of my knowledge and belief.
(Required.)
I agree
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11.
Please enter your name, title and company as it should be marketed publicly.
(Required.)
12.
Please include the phonetic spelling of your preferred name so we can ensure correct pronunciation of your name.
*
13.
Biography
(Required.)
Please upload a biography of 100 words or less. Please note that edits will be made to condense bios longer than 100 words.
Choose File
No file chosen
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14.
Headshot
(Required.)
Please upload a headshot with a resolution of 900x900 pixels or more in .jpeg or .png.
Choose File
No file chosen
15.
Additional Demographics (Please check all that apply.)
Male
Female
Disability
LGBTQIA+
Asian
Black
Hispanic or Latinx
Middle Eastern/North African
Native American or Alaska Native
Native Pacific Islander or Native Hawaiian
White
Multi-racial or Multi-ethnic
Other (please specify)
16.
Dietary Restrictions (if applicable)
*
17.
I acknowledge and consent to the Financial Health Network's
speaker release agreement
.
(Required.)
I agree
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18.
I acknowledge and consent to the Financial Health Network's
Terms of Participation
,
Terms of Use
, and
Privacy Policy
.
(Required.)
I agree
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