"*" indicates required fields There is no way to save a partial entry of this form, so make sure you have all of the required information and items ready before you begin! The deadline for submissions is Wednesday, December 13.Contact Information Please provide your contact information:Name* First Last Title* Company* Mailing Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Cell Phone*Office Phone* Ideas Festival Discussions The role of the facilitator is to encourage and guide positive dialogue during the round table discussions (Knowledge Communities, as we call them). To help us assess your application, please provide an example/story and one discussion question for each topic that you would share and pose, respectively, if selected as a facilitator.Artificial Intelligence: Risks and Rewards*Please provide one story/example and question for discussion. Fraud Trends*Please provide one story/example and question for discussion. Challenges for Agents in a Fluctuating Market*Please provide one story/example and question for discussion. Career Advancement Talks (Optional) Career Advancement Talks are breakout sessions that focus on an individual's growth and development, not necessarily related to title. Topics can include, but are not limited to leadership, managing employees, time management, women in title, finding a mentor. Please indicate if you are interested in being considered as a Career Advancement Speaker. (Additional fields will pop-up for you to provide information on specific topics).Please indicate if you are interested in being considered as a Career Advancement Speaker. (Additional fields will pop-up for you to provide information on specific topics). Yes Career Advancement Topic and Key Takeaways*Please briefly explain the topic(s) and key messages you would want attendees to take away from your proposed Career Advancement session(s).Additional Speaker Information Speaker Bio*Please upload a speaker bio in Microsoft Word or PDF format. If selected to speak, this bio will be used on the ALTA website and in any CE/CLE filings. Accepted file types: doc, docx, pdf, Max. file size: 4 MB.Speaker HeadshotPlease upload a headshot in JPG format, max 4MB. This headshot will be used on the ALTA website. If your upload fails, please submit the form without the bio and headshot files, but email those files to education@alta.org.Accepted file types: jpg, png, Max. file size: 4 MB. Check here if you do not have a headshot or don’t want your photo used on the ALTA website. Recent Speaking Engagements* Please provide information on up to 3 of your most recent speaker engagements.If you have not spoken publicly before, enter n/a for all values.Speaking Engagement*OrganizationEventTitle/TopicDateFormatCo-Presenters Add RemoveAdditional InformationPlease provide any additional information you would like us to know. Faculty Responsibilities: Participate as a Facilitator in all three Ideas Festivals (March 20-21) Participate in at least 2 Braindates Brief, non-traditional networking meetings based on expertise and interest To be completed onsite at ALTA SPRINGBOARD More information to follow Participate in up to 2 Training Webinars Dates will be sent, if selected Faculty Perks: Name on website Speakers receive a 50% discount on registration to ALTA Springboard. If selected, a 50% discount code will be provided to you. If not selected, we will work with you to honor the early-bird rate. (Please do not register before learning about the status of your application). Speakers are responsible for their own travel and accommodations. A link will be provided in the confirmation so that you can reserve your room. Speakers are required to sign and return a speaker agreement form. Confirmation:* Yes, I understand and agree to the Faculty Responsibilities and Perks above Human Verification:
