Midwest Chapter Speaker Confirmation

Thank you for speaking at our upcoming Midwest Chapter Annual Meeting. This program is in-person only. For our state liaison presentations, we will have the option to pre-record the presentation.

Once you fill out this form, EBA staff will register you for the meeting.

Speaker Form

I am participating as a(Required)

Moderator

Speaker

(Please select all that apply)

Your Name(Required)

(as you want it to appear on the EBA website and promotional information)

Your Organization Name

(as you want it to appear on the EBA website and promotional information)

Phone Number

Event Title

Session Title

(if the event has multiple sessions)

Are you currently a member of the EBA?

Yes