Please Complete This Form and Submit It To

CPBI SPEAKER FORM

Please complete this form and submit it to [email protected]

Speaker Contact Information:

Salutation:

First name:

Last name:

Job title:

Company name:

Phone:

Cell/Mobile Phone:

Email:

State or Province:

Country:

CPBI Member Status

Biography: This bio should highlight career or educational experience, awards, etc. Do not describe your organization's products or services. (You may attach a résumé if you wish)

CPBI Speaker Form V1-2011 Page 1 of 4 Speaking Experience: List any local, national or international speaking experience. If none, then list your experience speaking in front of groups of 15 or more or in teaching.

Description about your organization:

Session Information:

Title of session:

Have you delivered this session before?

If yes, what event/when?

Session Classification Please choose:

Benefits Pension Investment Communication Other, please specify:

Please provide Keywords (Keywords are words that the user enters in order to search for your session i.e.: health, workplace, DC, plan, design, …).

Language You can deliver the session in:

French English

Session Description: (For each area write a paragraph or two. Write complete sentences and be descriptive.)

Describe the issue or problem that this session addresses:

CPBI Speaker Form V1-2011 Page 2 of 4 Why is this topic of interest to the attendees? (What's in it for them?)

Learning Objectives: List at least 4 things the attendees will learn by attending this session (complete the sentence, "In this session, you will learn:")

1) 2) 3) 4)

Audience Level (Please double click to check one)

Novice

Intermediate

Advanced

Target Audience (Who should attend the session)

Audience Knowledge: (Indicate what knowledge or skill attendees should know in order to gain the most benefit from attending the session)

1) 2) 3) 4)

Teaching Method:

Lecture (theory) % Group Discussion %

CPBI Speaker Form V1-2011 Page 3 of 4 Case Study % 100 Problem Solving %

Please note that all presenters are required to:

 Prepare a PowerPoint presentation or one-page course outline to be provided to the CPBI 30 days in advance of your scheduled presentation – this is required for Accreditation purposes.  Conduct their 60 minute session on their assigned day.  Refrain from promoting their products or services during the presentation.

Post event access to session recording and presentation

Many CPBI sessions are recorded and archived on the CPBI website for attendees to view, should you wish not to be recorded or not to make your presentation (slides or outlines) available post event, please indicate it here.

Please complete this form and submit it to [email protected]

CPBI Speaker Form V1-2011 Page 4 of 4