Speaker Request Form

Request a CPSA representative to present at your next conference, professional development session or event.

  • Your Information

  • About the Event

  • Date Format: DD slash MM slash YYYY
  • If multi-day event/conference
    Date Format: DD slash MM slash YYYY
  • :
  • :
  • Please select all that apply.
  • Please enter a number greater than or equal to 1.
  • In minutes
  • i.e., Interactive/engaging, Q&A, webinar, formal/lecture, PowerPoint)
  • i.e., Are sponsorship dollars required in order to be a speaker?
  • Please list names and organizations.
  • i.e., Headshot and/or biography of speaker, CPSA logo and/or boilerplate, trade show booth set up, promotional items.
  • Date Format: DD dash MM dash YYYY
  • This field is for validation purposes and should be left unchanged.