ICAN Speaker Inquiry Form

Name of Speaker

Title + Organization/Affilation (if applicable)

Phone

U.S. State (Speaker's Primary Residence/Work):

Country (if not U.S.)

Name of individual submitting speaker for consideration (if different than speaker):

Relationship to Speaker:

SPEAKER DETAILS

Speaker Photo / Headshot:

Bio:

What topics do you/the speaker speak on? (please list topic titles and any other pertinent summary info - required)

Please supply link(s) to video clip(s) of speaker: (required)

Additional Information:

What is your fee?

ICAN is a non-profit, 501(c)3 organization, providing leadership development programming to men and women to develop inspiring, authentic leaders who transform and strengthen the organizations and communities they serve.

Do you offer a non-profit rate?

Have you spoken in Omaha, Nebraska before? (If so, please list date and organization)

Any additional documentation (Collateral, Profiles, Testimonials, etc.)

Contact Information