COFFEE TALK, Presented by the Business Resource Committee 2019 Speaker Application Form Name of Speaker*Date Company/OrganizationCompany Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneCell PhoneEmail Were you referred by a Chamber member?NoYesReferring Members NameAre you a current Chamber Member?NoYesIf no, would you like more information on membership? Please send me more information Please note that Chamber Members are given preference in the selection process. As a result, because of ourlarge membership base the majority of speakers are Chamber Members.Proposed TopicWhat qualifies you as an expert on this particular topic?What information are you going to provide our members with your content? How will this increase their Membership Value?Link to video/slide show of past presentation (professional quality not required) Upload PresentationAccepted file types: pdf, ppt, pptx.Are you interested in being placed on an “Emergency Speaker’s” list? Yes, please include me. If Selected You Must Provide: One of the following - Presentation Outline, PowerPoint or Take Away/Handout Speaker biography for introduction and headshot (if available) Guidelines for Presentations: Must ensure your program is interactive and engaging Your seminar may not be used as a sales tool or sales presentation in any way You must agree to – and abide by – the given time frame/theme of the event NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.