2013 ICBA Convention Speaker Proposal Form

• Speaker proposal deadline: September 1, 2012.
• Proposals will be reviewed by ICBA’s standing committee members. If you are selected, you will be contacted by December 1. Please do not call regarding the status of your proposal.
• Topics of an urgent regulatory or legislative nature take priority. Sessions appearing to be a sales pitch will not be considered. For continued consideration, a new proposal should be submitted annually.
• General Session speakers are selected by invitation to top regulators and secured through speaker bureaus.
• Honorariums are seldom provided. Most speakers will present for expenses and exposure only.

PROPOSED SESSION INFORMATION:
	Workshop Title:
	Workshop Description:
	Why should ICBA select you as a speaker?
	Why is your topic important to community banks?
PRESENTERS INFORMATION:
	Name:
	Title:
	Organization:
	Address:
	City:
	State:	- Please Select - AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingNone
	Zip:
	Phone:
	Email:
	Web Site:

ADD AN ADDITIONAL PRESENTER (Click here):

	Name:
	Title:
	Organization:
	Address:
	City:
	State:	- Please Select - AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingNone
	Zip:
	Phone:
	Web Site:
	Email:

SUBMITTER INFORMATION:
	Name
	Phone
	Email

indicates a required field