CIA Guest Speaker RequestName *Email *Phone *no dashes (8003851755)Job Title *Company *Tell us about yourself *Please provide a brief bio we can use to promote you as our guest speakerInstagram or Facebook Handle Areas of Expertise *Please give us some background information regarding your experience in the industry and what would make you a qualified speaker for our events.Proposed Session Please give detail on the topic you will be presenting including format, title and session goal.File Upload Please attach a high-quality professional photo.Comments Please feel free to add any other information you feel would be helpful or relevant to your presentation.Acknowledgement *If chosen to speak, I give permission to Earp Enterprises to record a video of my presentation at the CIA events. This may be shared on the website, social media or newsletters. In addition, I give Earp Enterprises permission to use my name, photo, video and biography in marketing and promotional materials for CIA events. I understand that my session is not a platform for promotion of my business, practice or conduct. I agree to refrain from political agendas or inappropriate subjects. CIA events are noncommercial forums, the direct promotion of products and services is prohibited.Yes I agreeOption 3 VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>: