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ELECTIVE WORKSHOP
SPEAKER APPLICATION FORM

ACFW 2015 NATIONAL CONFERENCE

DEADLINE TO APPLY: Monday, December 15, 2014

Privacy Statement: Please note, all personally identifying information collected will only be used within our organization

Name
Are you currently a member of ACFW?
Contact Info
(Please include country and area code as applicable)
Workshop

List of speakers if more than one:
First Name Last Name
Attach Copies of Handouts (required)

Please be sure your name and Workshop title appear in the upper left hand corner of each page you submit. Document(s) MUST be named with your proposed Workshop title and last name. EX: WriteTight1_SMITH.doc, WriteTight2JONES.doc, etc. -- use no spaces or punctuation in the document name other than an underscore ( _ ) or a hyphen ( - ) Attached files can be no larger than 500 kilobytes (512,000 bytes or .48828 megabytes) - only .doc (MSWord), .rtf (Rich Text Format), .wpd (Word Perfect), .pdf (Adobe), .xls (MSExcel) and .txt (Plain Text) file types are allowed.

Authorization for Media Reproduction

In the event your proposal is accepted, your Workshop presentation will be recorded and duplicated for distribution (in either audio or video format, or both). All costs for media reproduction will be covered by ACFW and all proceeds from the sale of the distribution media will be the property of ACFW. Because of ACFW's contract with the hotel and recording companies, all recording and/or videotaping is only allowed by ACFW or ACFW's contracted recording company. Please acknowledge that you have read, understand and consent to release such authorization by placing a checkmark in the box below.