Speaker Application Intake Form

I am a:

Retailer/Product manufacturer
Service Provider

RILA Member:

Yes
No

If you are a service provider, are you already signed up to exhibit/sponsor?

Yes
No

Proposed session title:

Proposed session description & format of presentation (600 character maximum):

Significance of topic for attendees and key takeaways from the session:

Lead Speaker

Name:

Title:

Company:

2nd Speaker

Name:

Title:

Company:

3rd Speaker

Name:

Title:

Company:

Contact information for Lead Speaker (not included in promotional materials)

Phone:

Email:

Fax: