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Request a Speaker/Interview

Request Form

1. Are you interested in becoming a Compliance Liaison Partner?
  Yes      No
   
2. Are you interested in having a speaker at your event?
  Yes      No
   
3. What are the preferred dates and location of your event for a speaker?
  Date:
  Location:
   
4. Is there a particular issue you want us to speak about?
  Yes      No
   
5. If yes, what is the issue(s)?
 
  Other (Write In)
     
6. Are you a small-medium size enterprise (SME)?
  Yes      No
   
7. Organization Name and Contact Information:
  Name:
  Contact Name:
  Contact Phone:
  Email
     
3. Other Comments or Questions related to Requesting a Speaker or Compliance Liaison Partnership:
  Indicate here if this is a follow up request