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About You

Primary Email Address

Gender

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First Name

Are you a CPA?

Yes No Not yet but working on it

Last Name:

Birthdate

Title

Designation(s) Please separate designations with a comma.

Mobile Phone

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Mobile Phone is a non-USA or Canada number.

Company (Search by company name) Min. 3 characters and is not case sensitive. Can't find your Company?

Country

Street Address

Apt, Suite, Bldg., etc.

City

State

Zip / Postal Code

Company Phone

( )

Company Phone is a non-USA or Canada number.

Web Account

UserID: (Your UserID is your email address.)

Password:

Confirm Password:

Password must be a minimum 6 characters. For your own protection, select a password that is unique to our site and change it on a regular basis.

Interested in

(Check all that apply):

Speaking at in-person meetings Speaking via webinar/webcast Writing Being on video

Do you require a fee to speak

Yes No

Please list any organizations and contact person that you’ve spoken for that we can reach out to as a reference:

If there are any specific presentation(s) you’d like to propose, enter them below:

1.	0	Session Title	Remove Session
	Description:
	Have you presented this presentation before? Yes No
	To which organization(s):

Do you have previous writing experience?

Yes No

Please provide example(s) below:

	Title	Link(URL)	Publication/Website
1.	0			Remove
2.	0			Remove
3.	0			Remove

If there are any specific article topics/concepts you’d like to propose, enter them below:

	Topic
1.	0		Remove

Have you appeared on video before?

Yes No

If there are any specific video topics/concepts you’d like to propose, enter them below:

	Topic	Est. Length
1.	0			Remove

Please provide any additional comments, if applicable, including your general availability or blackout times

Terms and Conditions:

Sales-oriented presentations or articles are not permitted. Materials must be presented for educational purposes and should not promote a product/service exclusively.
I authorize the NJCPA to share my contact information with volunteer members involved with planning meetings.
Submission of this form does not guarantee that the NJCPA will engage you to speak, write or appear on video.

I agree to the terms and conditions.

Subject Matter Expert

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