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Name of Your Organization:
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First Name:
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Last Name:
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Phone:
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Fax:
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Email:
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Website:
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Description of Product:
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TCUL Events You Are Interested In Presenting for:
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Short Bio of Presenter (Please limit to 75 words or less):
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Why are You interested in Presenting for TCUL (Please limit to 50 words or less):
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Topics You are Interested in Presenting or Titles of your Topics (Please limit to 100 words or less):
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Learner Outcome (Please limit to 50 words or less):
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Amount of Time for Session:
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Target Audience:
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If Other, Please Specify:
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Financial Industry References (5 references max w/ contact info):
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Speaker Fees:
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I Fly from (city/state):
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Will you be presenting in the DFW area where we could view your presentation in person? If so, when, where and what time?
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