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EMERGE Live Speaker Registration
Registration for speakers for the Financial Health Network's EMERGE Live Virtual Conference, June 22-26.
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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.)
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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.
Assistant Name
8.
Assistant Contact
9.
Please provide contact information for ONE additional person that should be included on your correspondence.
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10.
I certify that all of the information above is to the best of my knowledge and belief true, correct and complete.
(Required.)
I agree
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11.
Please enter your name, title and company as it should be marketed publicly.
(Required.)
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12.
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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13.
Headshot
(Required.)
Please upload a headshot with a resolution of 900x900 pixels or more in .jpeg or .png.
Choose File
No file chosen
14.
Diversity and Inclusion (Please check all that apply.)
Male
Female
Disability
LGBTQ
Black or African-American
White or Caucasian
Hispanic or Latino
Native American or Pacific Islander
Asian
Other (please specify)
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15.
I acknowledge and consent to the Financial Health Network's
speaker release agreement
.
(Required.)
I agree
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