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. 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:
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):
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