UA17. Events. Women In Leadership Speaker Registration Form - Lewis University

Women LEADership Series Speaker Application Form

Contact Information

First Name*

Last Name*

Maiden Name (if applicable)

Email*

Home Number*

Cell Number:*

Lewis University Graduation Information

What year(s) did you graduate from Lewis University?*

What program did you earn your degree(s) in?*

Not an Alum- how did you find out about this?

Career Information

What is your current job title?*

What company do you currently work for?*

Pertinent Career Information (Insert Bio or LinkedIn url):

Session Proposal

What field(s) have you been a leader:

Proposed Session Title*

Proposed Session Description and Significance*

What do you want attendees of your session to learn?*

Please list any previous speaking engagements*

Share any other pertinent information about your background that you would like the Advisory Committee to know.