First Name (required)

Last Name (required)

Company / Firm Name (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Phone (required)

Phone Extension

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Your Email (required)

CE
We intend to apply for CE credit with CA, FL, OK and TX for this conference. Please check with your state for CE reciprocity.
Although we make every attempt to obtain CE credit, we do not represent credit will be awarded by any state.

CLE
Please list the state(s) and bar number(s) after your name for any state you require CLE for conference attendance.

The speaker applying should be the person intending to present at the conference, as FETTI does not allow substitution of the approved speaker.
Speaker Qualifications: (Years in specialized industry, degrees, certificates, other recent speaking engagements, etc…).

Have you spoken at any other industry events?
YesNo

If so, which program(s) and on what topic(s)?

What topics would you be interested in presenting? Please identify the topic(s) below and attach an outline for each topic, providing detail.

Are you willing to prepare an article and PowerPoint to support your presentation?
YesNo

Please attach a speaker bio, outline and any other pertinent materials to this form. You will be contacted if you have been chosen to speak.