1. PLANADVISER National Conference Request for Speakers

This form is to identify interested speakers for the PLANADVISER National Conference, to be held September 10-12, 2012 at The JW Marriott in Orlando, Florida.

More information about the conference can be found on the conference Web site at: http://www.planadviser.com/event/panc2012/

We are accepting information from those interested in speaking or moderating during the three day conference. We will be accepting "applications" for speakers and moderators though July 1 and will then begin to place people on panels. This is not first-come, first-serve.

If you are selected as a speaker or moderator, we will waive your conference registration fee (which includes all meals) and comp one night of your hotel room at the JW Marriott.

Please note: each speaker and moderator is expected to participate ahead of the conference. More specifically, speakers are required to submit key points about their panel topic and moderators are required to compile an outline of discussion for each panel, and all are required to take part in a pre-call (for speakers unable to attend the call they must catch up with their moderator afterwards).

Failure to complete the required work ahead of time may result in your being replaced as a panelist and/or losing your complimentary room/registration fee.

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* 1. Your information

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* 3. Who is your broker/dealer or custodian?

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* 5. What is your target market for retirement plans (check all that apply)?

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* 6. Please paste in a short bio for us to post on the conference Web site if you are chosen as a speaker (100 words or less).

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* 7. Have you attended PLANADVISER National Conference in the past?

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* 8. Are you planning to attend PLANADVISER National Conference this year?

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