Speaker Proposal Form

Describe the premise of your proposed session. Why this is important to the attendee, and MOST importantly, describe 2-3 datapoints that the attendee will walk away with, why this benefits them.

Session Title:

Description (80 to 100 words):

Suggested Track:

Speaker's Account Profile Information:

First Name:
Last Name:
Title:
Company:
Address:

City:
State:
Zip:
Country:
Phone:
Fax:
E-mail:

Speaker's Bio:
Provide a short, relevant biography: your background, experience and why you are the expert in this area. (100 words or less)

Contact Person:

Please enter the name and contact information of the person responsible for correspondence regarding this proposal submission, if that person is not the speaker entered above.

Contact's Name:
Contact's Phone:
Contact's E-mail:

Release agreement:
Please read the following and indicate your approval by marking the box below.

I acknowledge that audio tapes, photographs, videotapes and other media including CD-ROM disks may be produced from the various lectures, speaker sessions, panel discussions, keynotes and hand out materials presented at all Jupitermedia events, including presentations given by panel discussions and myself in which I participate. I further acknowledge that such compilations of these materials may be sold or provided free of charge by Jupitermedia, to registered attendees of these events and other individuals.

I hereby give my permission, in perpetuity, to Jupitermedia, and their agents and representatives, to record and distribute audio tapes, photographs, videotapes and other media, including CD-ROM disks, which contain all or a portion of any presentations I give, papers I present, hand out materials I distribute and panel discussions in which I participate at any Jupitermedia event, without any obligation on their part to pay me any fee or royalty.

Having given the above permission, I retain the right to terminate said permission but must do so in writing to Jupitermedia at least 120 days prior to the event.

I AGREE TO THE RELEASE AGREEMENT

SILVER SPONSORS

ASSOCIATION AND ANALYST PARTNERS

MEDIA PARTNERS