NOTE: The Applicant should be the person intending to present at the conference; FETTI does not allow for substitution of the approved Applicant speaker.

Applicant First Name (required)

Applicant Last Name (required)

Applicant Company / Firm Name (required)

Applicant Address (required)

Applicant City (required)

Applicant State (required)

Applicant Zip Code (required)

Applicant Phone (required)

Applicant Phone Extension

Applicant Mobile Phone (required)

Applicant Email (required)

NOTE: The Contact Person fields only apply if a person is submitting this speaker application on behalf of the Applicant.

Contact Person First Name (if different from Applicant)

Contact Person Last Name (if different from Applicant)

Contact Person Email (if different from Applicant)

Contact Person Phone (if different from Applicant)

Contact Person Phone Extension

Contact Person Mobile Phone (if different from Applicant)

If the application includes a panel, please provide the name, company, phone and email contact information for all of the panelists here.

Speaker Qualifications: (Years in specialized industry, degrees, certificates, other recent speaking engagements, etc…).

Has the Applicant spoken at any other industry events?
YesNo

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

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

Is the Applicant willing to prepare an article and PowerPoint to support their presentation?
YesNo

Please attach a speaker bio, outline and any other pertinent materials to this form.
*The following file formats are accepted: .pdf, .txt, .ppt, .pptx, .doc, .docx

ACKNOWLEDGMENT OF APPLICANT DEADLINES AND IMPLICATIONS FOR CONTINUING EDUCATION ("CE")

FETTI intends to apply for CE credit with CA, FL, OK and TX for this conference. In order to obtain CE credit, FETTI must apply to each state prior to the conference. Doing so requires the Applicant's cooperation with FETTI in attending to several deadlines several months prior to the conference for submissions of outlines, PowerPoints, bios, summaries, etc. These submissions can change for the Applicant's presentation, but FETTI must have the current version of the documents requested by the deadlines provided below.

The key deadlines are as follows, including the conference date itself:

1. 4/3/23: application deadline
2. 6/5/23: selected Applicants' timed outline, bio and a PowerPoint with accompanying materials for the presentation due
3. 8/14/23: selected Applicants' final PowerPoint with accompanying materials for the presentation due
4. 9/27/23 to 9/29/23: Applicant and its panel, if applicable, to attend the FETTI conference at the Union League Club in Chicago, Illinois

Is the Applicant and its panel, if applicable, able to meet each of these deadlines?
YesNo

Thank you for taking the time to complete a speaker application for FETTI this year! The Applicant will be contacted if they have been chosen to speak.

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