Conference Speaker Form Contact InformationName(Required) First Last Preferred Name First Job Title(Required)Agency/Organization(Required)Email(Required) Address(Required) Street Address City State / Province / Region ZIP / Postal Code Work Number(Required)Mobile Number(Required)Only used in the event of last-minute schedule issues or similar emergencyPlease include your brief Bio for introductionsFile uploadMax. file size: 50 MB.MaterialsDo you plan to prepare a PowerPoint Presentation?(Required) Yes No Title and brief description of presentationFileMax. file size: 50 MB.If yes, does your presentation include video or sound clips?(Required) Yes No Do you plan to prepare a handout in addition to the PowerPoint Presentation?(Required) Yes No FileMax. file size: 50 MB.Material Use Agreement(Required) I agreeBy participating as a presenter, I agree to submit a PowerPoint presentation, manuscript, or other handouts in connection with this program, and I am giving my permission for the North Carolina Conference of District Attorneys (“the Conference”) to use this presentation and materials for continuing legal education purposes. I also agree that the presentation and materials may be distributed by the Conference in any of the following formats: (1) electronic or physical copies; (2) as part of a video replay; or (3) as part of a live webinar that may be offered for continuing legal education credit. I represent that no other entity holds a copyright to any submitted materials that would prohibit their use for continuing legal education purposes. Alternatively, if copyright permission is required, I have obtained and will provide the Conference with the copyright holder’s permission prior to the use or distribution of this material. Finally, I give the Conference discretion to edit this material before any use or publication, including the right to redact, remove, or replace any copyrighted images with suitable non-copyrighted images, if necessary. Audio/VisualPlease indicate additional equipment required for your session Flipchart Lapel Mic Handheld Mic Internet TravelDo you need a room reservation?(Required) Yes No Check-in date:(Required) MM slash DD slash YYYY Number of nights(Required)Do you need a flight?(Required) Yes No Departure City(Required) City State / Province / Region Departure Date(Required) MM slash DD slash YYYY Departure Time(Required) Hours : Minutes AM PM AM/PM Return Date(Required) MM slash DD slash YYYY Return Time(Required) Hours : Minutes AM PM AM/PM Airline Preference(Required)Please include any additional information hereDo you have dietary restrictions?(Required) Yes No If yes, please explain
