Speaker Proposal Application Form

Section 1: Speaker Information

Full Name*

Email*

Phone Number*

Job Title

Address

Organization/Company Name*

Social Media Handles

Instagram

Twitter/ X

Other

Section 2: Proposed Topics

Presentation Title(s)*

Brief Description of Proposed Topic(s)*

Learning Objectives*

Target Audience

(Optional, e.g., Event Planners, Corporate Marketers, etc.)

Which MPI Georgia event would you like to speak?*

Education Luncheon

Spring Summit

Leadership Webinar

All of the above

Format Preference*

Keynote

Panel Discussion (1 moderator, 2-3 panelists)

Fireside Chat (1 interviewer, 1 interviewee)

Workshop (Interactive)

Length of Presentation *

30 minutes

45 minutes

60 minutes

90 minutes

Section 3: Demographic Information

Optional: To ensure the chapter is aligned with its commitment to diversity, equity, and inclusion.

Race/Ethnicity (Please Specify)

Do you identify as part of any marginalized social identities? (Select all that apply)

Marginalized social identities (please specify)

Select or enter value

I agree to uphold the EDI principles in my presentation and delivery*

Section 4: Compensation MOU

As a Chapter of Excellence, we are committed to providing meaningful engagement opportunities for our speakers. The MPI GA Education Committee deeply values the expertise, time, and effort that speakers dedicate to delivering impactful presentations.

We recognize that your contributions are instrumental to the success of our events, and we sincerely appreciate your willingness to share your knowledge with our community.

In the spirit of transparency, we understand that exposure alone may not always be sufficient. While we ask that selected speakers generously provide their services in-kind, we are open to discussing potential compensation. If you would like our Education Committee to consider this, we are happy to provide our Compensation Overview upon request.

Form Date Field*

Final Submission

Upload Materials*

Sample Slide Deck or Related Materials (Optional)
Resume or Speaker Bio (Required)
Headshot (Required)
Additional Notes or Special Requests (Optional)

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