Speaker Database Submission Form

Use this form to submit for addition to the Cognificent Learning speaker database. By completing this form you are agreeing to our privacy policy and terms of service. Submitting this form does not guarantee admission to the database, nor does it indicate acceptance to have content on the Cognificent Learning website which is by invitation only.

"*" indicates required fields

Speaker Name*

Prefix First Last Suffix

Instructor's Business Address*

The instructor's address will be visible for conference planners who may wish to hire a speaker based on their location.

Street Address Address Line 2 City State ZIP Code

Headline*

Add your headline here. It should be very succinct (75 character limit) and indicate what you speak about. Be as general or as specific as is appropriate. An example of a general type of headline would be "Leadership and Culture" and a specific example would be "Corporate Tax Law in Florida."

Promo Photo*

You may attach up to two promotional photos of up to 50MB a piece. The preferred format is JPG.

Drop files here or

Accepted file types: jpg, png, Max. file size: 50 MB, Max. files: 2.

Bio*

Please copy and paste your bio here. Maximum of 1800 characters (about 300 words).

Would you like a promotional video in your profile?*

We highly recommend having a brief video introduction or speaking highlight reel available for conference planners to view. We accept YouTube or Vimeo links. Please keep your video to 5 minutes or less. *If you are a Cognificent speaker and had Cognificent's film team produce your content, then Cognificent will produce the promo video and insert it upon your request.

Yes

I'm not a Cognificent speaker yet. Please contact me - I'd like to talk about having Cognificent produce a promo video for me

I am a Cognificent speaker (or in the process). Please insert my promo video on my behalf.

Link to promo reel

Copy and paste the link to your promo reel (of five minutes or less) hosted on Vimeo or YouTube. This can be added later if you are a speaker with content on Cognifcent.

Fees:

My fees are:*

Topics and Audience

I speak for the following session types:*

Do not select a session type that you cannot provide a reference for if asked. Select all that apply.

1-2 hour conference sessions, seminars, or workshops

3-4 hour conference sessions, seminars, or workshops

4-8 hour conference sessions, seminars, or workshops

1-2 hour large conference keynotes (500-1000 people)

Audience(s)*

Select the main audience(s) for your content. Remember that your content will likely be used to provide professional education credit that may require preapproval of you or your content by a licensing, regulatory or certification offering agency or association. Select all that apply but DO NOT select a group for which you don't have experience speaking.

Auditing and Accounting

Change Management

Law Enforcement (Policing)

Legal (attorneys)

Home/Building Inspection

Executives/Board of Directors

What topics do/can you speak on as a subject matter expert?*

Check the applicable topic areas for the content. Select all that apply.

Technical industry topics

Ethics

Communication

Leadership

Diversity Equity & Inclusion

Law

Tax

Change Management

Economics

Statistics

Organizational culture and psychology

Fraud

Wellness

Feedback & Past Clients

Client list

Attach a list of your past clients

Drop files here or

Accepted file types: jpg, pdf, png, doc, Max. file size: 10 MB, Max. files: 2.

Copies of feedback reports

(optional) Attach a copies of previous feedback

Drop files here or

Accepted file types: jpg, png, pdf, doc, Max. file size: 5 MB, Max. files: 10.

Speaker Contact Information

Website

Phone

Consent to be listed in the Cognificent speaker database*

The instructor understands that the information supplied on this form will be visible by employees, learners and partners of Cognificent Learning. Partners will be able to use your profile to download your promotional photo, bio, and other information you submit. Unsolicited marketing of any kind to any other Cognificent Learning members is strictly prohibited and will result in removal from the database and revocation of membership in the Cognificent Learning website. Cognificent Learning waives all liability for inadvertent disclosure of instructor information to unintended groups. No speaker profile will be added to the database until approved and any profile may be amended or updated as deemed necessary by Cognificent Learning staff, or removed without notice and for any reason or no reason. Cognificent Learning cannot control nor does Cognificent Learning bear any responsibility or liability related to how users or members use the data submitted.

The information in this submission is true and accurate to the best of my knowledge and I agree to have my information listed in the Cognificent speaker database. By clicking, you accept the Cognificent Learning Terms of Service and Privacy Policy.

Speaker Database Submission Form

Fees:

Topics and Audience

Feedback & Past Clients

Speaker Contact Information

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