Speaker Application

NIPHLE Training Conference
Fort Walton Beach, FL

May 14-17, 2007
Ramada Plaza Beach Resort

Speaker Application
Speaker Information

Fax completed form to Richard Owen
(570-23-0606)
or email
Word Document Form to niphle@dejazzd.com

Speaker Name/Title
Employer
Address
City
State/ZIP
Phone/ Fax/Email
Topic
Summary of Talk (35-50 words)
Length of Presentation
Please provide a Short (35-50 words) Biographical Paragraph for NIPHLE's Program Materials

Equipment Requirements

Overhead PowerPoint Presentation Will bring your own computer yes no
Your presentation will be stored on: USB Drive CD DVD Zip Disk (100mb)
Other

Who from NIPHLE asked you to speak?

Fax completed form to Richard Owen (1-866-4NIPHLE) or email: niphle@dejazzd.com

Please remember to make your hotel reservations and submit a conference registration form if you will be attending the entire conference!

Conference Schedule	Conference Speakers Needed	Help Sponsor a Conference Event
Conference Registration	Conference Speaker Application	Sponsorship Form
Exhibit Opportunity	Panel Application	Table Top Display Registration

		NIPHLE Training Conference Fort Walton Beach, FL May 14-17, 2007 Ramada Plaza Beach Resort
Speaker Application Speaker Information

Fax completed form to Richard Owen (570-23-0606) or email Word Document Form to niphle@dejazzd.com