Webinar Presenter Information Form

**Reminder** Please ensure you have all the required information listed below. As you can not save this form and return to it later. If you have issues or questions please email: events@nexus4change.org

The form below allows for up to 6 presenters’ information to be submitted only the main presenters are required.

Presenter Information

Presenter #1 Information (Required)

Name *First and Last
Email *Enter a email address we may contact you at.
Organization *
Title *What is your job title?
Bio Picture (8mb file size limit) *Upload a picture you would like us to use.
Bio (150 words max) *Please provide us with a short bio.
Alternative EmailProvide us with an alternative email attendees could contact you at. If left blank we will use your contact email.
WebsiteProvide us with a website address to your company website or your personal website for attendees to visit.
Social NetworksPlease provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page, if you have one.
Linkedin URL

Presenter #2 Information

NameFirst and Last
EmailEnter a email address we may contact you at.
Organization
TitleWhat is your job title?
Bio Picture (8mb file size limit)Upload a picture you would like us to use.
Bio (150 words max)Please provide us with a short bio.
Alternative EmailProvide us with an alternative email attendees could contact you at. If left blank we will use your contact email.
Website Provide us with a website address to your company website or your personal website for attendees to visit.
Social NetworksPlease provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page, if you have one.
Linkedin URL

Presenter #3 Information

NameFirst and Last
EmailEnter a email address we may contact you at.
Organization
TitleWhat is your job title?
Bio Picture (8mb file size limit)Upload a picture you would like us to use.
Bio (150 words max)Please provide us with a short bio.
Alternative EmailPlease provide and alternative email you would like attendees to contact you at. If you leave this blank we will use your contact email.
WebsiteProvide us with a website address to your company website or your personal website for attendees to visit.
Social NetworksPlease provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page if you have one.
Linkedin URL

Presenter #4 Information

NameFirst and Last
EmailEnter the email address you would like to use for us to contact you.
Organization
TitleWhat is your job title?
Bio Picture (8mb file size limit)Upload a picture you would like us to use.
Bio (150 words max)Please provide us with a short bio.
Alternative EmailPlease provide and alternative email you would like attendees to contact you at. If you leave this blank we will use your contact email.
Website Provide us with a website address to your company website or your personal website for attendees to visit.
Social Networks Please provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page if you have one.
Linkedin URL

Presenter #5 Information

NameFirst and Last
EmailEnter the email address you would like to use for us to contact you.
Organization
TitleWhat is your job title?
Bio Picture (8mb file size limit)Upload a picture you would like us to use.
Bio (150 words Max)Please provide us with a short bio.
Alternative EmailPlease provide and alternative email you would like attendees to contact you at. If you leave this blank we will use your contact email.
WebsiteProvide us with a website address to your company website or your personal website for attendees to visit.
Social NetworksPlease provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page if you have one.
Linkedin URL

Presenter #6 Information

NameFirst and Last
EmailEnter the email address you would like to use for us to contact you.
Organization
Title What is your job title?
Bio Picture (8mb file size limit)Upload a picture you would like us to use.
Bio (150 words max)Please provide us with a short bio.
Alternative EmailPlease provide and alternative email you would like attendees to contact you at. If you leave this blank we will use your contact email.
WebsiteProvide us with a website address to your company website or your personal website for attendees to visit.
Social NetworksPlease provide your social network information you would like to share with attendees.
Twitter URL
Facebook URLThis could be your personal profile or a Facebook Page. We recommend a Facebook Page if you have one.
Linkedin URL

Webinar Information

Webinar Series *Select the webinar series you would like to present on.
Webinar Title *Provide us with a title for your webinar.
Webinar Description (250 words max) *Please provide us with a brief but detailed description of your webinar.
Webinar Date Please provide us with a your top three choices for a date you would like to conduct your webinar. All webinars start at 2pm EST. If this time does not work for you please specify an alternative time below. Please select days that fall on Tuesday, Wednesday or Thursday.
Alternative Time
Webinar Date #1
Webinar Date #2
Webinar Date #3

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank: