Speaker Form

Please fill out the speaker form below. For questions pertaining to the speaker form, please email Ashlee@MichiganPremierEvents.com.

Please make sure to include the event title and session in the subject line of the email.

Speaker Interest Form

First name

Last name

Title

Company name

Phone

Speaker Biography (250 Words Max) *

Presentation Topic

Main Audience

About the Presentation

Educational / Professional Qualifications

Speaker Headshot

Please provide 3-5 sentences about your company.

Company Logo

Website

Social Media Handles

Special Requests: Please inform us of any dietary restrictions, allergies or other special requests below.

I have verified that all information provided is accurate and complete.

I understand and agree that media may be used in formats, including print, digital and online media, and may be distributed through various channels such as websites, social media and promotional materials.

Signature

517.220.4628

Speaker Form

Speaker Interest Form

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