2015 US Lacrosse National Convention
Program Administrator


Deadline: October 1

SPEAKER INFORMATION

Today's Date (mm-dd-yyyy)
*First Name
*Last Name
*Email Address
*Re-enter email address
*Street Address
*City
*State
*Zip Code
*Phone Number
(best way to contact)
*Title/Position
(in the lacrosse industry)
*Organization
*US Lacrosse Member Number
(Forgot your member number? Click here to retrieve it! Do not have a member number or its expired? Please click here to sign-up or renew your membership.)
*Have you previously presented at the US Lacrosse National Convention?
If yes, which year(s)?
Shirt Size
(Women's Polo's are cut a little small/short)
*SPEKAER BIO (No more than 500 words)

FACEBOOK Page
(Social media is a big part of our Convention marketing plan to promote speakers prior to the Convention)
TWITTER Handle
(Social media is a big part of our Convention marketing plan to promote speakers prior to the Convention)

PRESENTATION INFORMATION


*PRESENTATION 1
*Presentation Title
*Topic
*Key Words/Skills Learned/Brief Description
(Please List 3-5 keywords/skills/concepts that will be taught in this session).
*Presentation Format
(Please note that if you select "demonstration" this does not guarantee a Live Field spot. You might be asked to present your demonstration in a classroom setting).

Co-Speaker Full Name
Please list each co-presenter's name including organziation, email address, and PERCENTAGE OF SPEAKER FEE TO BE SPLIT.

PRESENTATION 2
Presentation Title
Topic
Click here for description of each topic.
*Key Words/Skills Learned/Brief Description
(Please List 3-5 keywords/skills/concepts that will be taught in this session).
Presentation Format
(Please note that if you select "demonstration" this does not guarantee a Live Field spot. You might be asked to present your demonstration in a classroom setting).

Co-Speaker Full Name
Please list each co-presenter's name including organziation, email address, and PERCENTAGE OF SPEAKER FEE TO BE SPLIT.

PRESENTATION 3
Presentation Title
Topic
Click here for description of each topic.
*Key Words/Skills Learned/Brief Description
(Please List 3-5 keywords/skills/concepts that will be taught in this session).
Presentation Format
(Please note that if you select "demonstration" this does not guarantee a Live Field spot. You might be asked to present your demonstration in a classroom setting).

Co-speaker full name
Please list each co-presenter's name including organziation, email address, and PERCENTAGE OF SPEAKER FEE TO BE SPLIT.

DAY/TIME

Please keep in mind that the day and time you select is a request and we will do our best to accommodate, however you will need to be available Friday and Saturday if selected to speak.
*Please select the day you would prefer to speak
*Please select time of day you would like to speak
(This does not guarantee you will get your slot time)

QUALIFICATIONS/REFERENCES


*1st Reference:
*Reference Name
*Reference Email Address
*Reference Phone Number

2nd Reference (Optional):
Reference Name
Reference Email Address
Reference Phone Number



Additional Comments