Speaker Moderator Form

First Name

Last Name

Credentials

Company

Job Title

Mobile Phone

Office Phone

Street Address

City

State

Zip code

Website

Facebook

Presentation Title

Subtitle

Description or Abstract approxiamately 200-250 words:

Brief Bio

Headshot (Max 50 MB):

Non-standard A/V Requests? Breakout Rooms will have Projector, Laptop, Screen, & Podium. Keynotes & General Session Panels include microphones:

Additional Requests

Consent: I consent to allow the information submitted to be publicized on www.TexasCECON.org, social media platforms, and email marketing. Publicity includes, but not limited to, promotion of headshot, name, and description of program.

Speaker Moderator Form

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