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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:

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 use the following field to provide:

Links to samples of your work if not already provided above (e.g., videos of your presentations, handout materials, articles you've written)
Any additional comments, 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.

ABOUT YOU