NASSP Speaker Interest Form

Thank you for your interest in speaking at one of our NASSP events. This form is a means of introducing yourself to us and providing us with your contact information, speaking references, and overview of your presentations.

Only completed forms will be reviewed and considered.

NASSP policy prohibits the sale of goods or services during conference sessions and presenters may not display or distribute brochures or order forms. Referencing or citing a presenter’s own publication(s) is acceptable.

Speaker Information

First Name*

Last Name*

Email*

Confirm email address*

Street address*

City*

State/Region*

Zip Code*

Country/Region*

Phone number*

Mobile phone number

_____________________________________________

Professional Information

Speaker Website *

Put N/A if not applicable

Business/Speaker Bureau Name *

Put N/A if not applicable.

Contact/Representative Name*

Put N/A if not applicable.

Contact/Representative Phone Number *

Average Speaking Fee for an Educational Organization *

Put N/A if not applicable.

Have you ever served as a School Leader (Principal, Assistant Principal, Dean, Teacher Leader)*

Yes

_____________________________________________

Presentation

Please identify the title of one (or more) keynote presentations and provide a short annotated description of the topic, purpose, and target audience for each.

Title of Presentation*

Please select which strand this presentation falls under*

Description of presentation *

Up to 100 words.

_____________________________________________

References

Please list two (2) schools or school leaders for whom you have delivered keynote speeches or presented workshops within the last 12 months.

Reference 1

Reference 1: School/Organization*

1: Title of Presentation Delivered*

1: Size of Audience to Whom You Presented*

1: Format (check all that apply)*

Large Group Assembly/Presentation

Keynote Presentation

Workshop

1: Location*

School Level

State/Regional Level

National Level

1: School Leader of Organization Contact Name*

1: School Leader or Organization Contact Email*

1: School Leader or Organization Contact Phone Number *

Reference 2

Reference 2: School/Organization*

2: Title of Presentation Delivered *

2: Size of Audience to Whom You Presented*

2: Format (check all that apply)*

Large Group Assembly/Presentation

Keynote Presentation

Workshop

2: Location*

School Level

State/Regional Level

National Level

2: School Leader or Organization Contact Name*

2: School Leader or Organization Contact Email*

2: School Leader or Organization Contact Phone Number*

_____________________________________________

Speaking Preferences

Please select the choices that reflect your preferences (check all that apply):

I would like to be considered for:*