Prospective TML Speaker Information

Please provide the requested information to be used in the speaker selection process. All information must be completed to be considered. required fields are marked with an *. If you do not fill in a required field, and submit the form anyway, it will erase all your entered data. If you have questions or problems with this form, please call Kim Pendergraft at 512-231-7400 or e-mail speakerinfo@tml.org.

*Program Title:
*Suggested Target Audience:
*Brief Presentation Description:
*Program Learning Outcomes: (What do you envision attendees learning?)
*Presentation Format: (Hold down the Ctrl key to select multiple instructional methods.)
Other Format:
Have you presented on a Webinar?	Yes No
Would you consider presenting on a Webinar?	Yes No
Please suggest topics you feel would work well in Webinar format.
*Equipment Needed for Presentation: (Hold down the Ctrl key to select multiple items.)
Other Equipment:
*First Name:
*Last Name:
Job Title:
City/Organization:
Mailing Address:
*Phone:
Fax:
*E-mail Address:
Yes, I have presented this topic before.	Yes No
Dates of most recent presentation(s):
Location(s) of most recent presentation(s):
References for the above presentation(s) If you are from a private sector organization, please provide Texas city-related references.:
*What qualifies you to make this presentation?
*Career Highlights:
*Do you expect an honorarium?	Yes No
If yes, how much of an honorarium do you require?
*Do you need your travel expenses to be covered in order to present?	Yes No