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Inside Advertising Speakers Program

Participation Form

Name:
Title:
Company:
Address:
City, State Zip:
Phone #:
Fax #:
Email:
Assistant:
Assistant's Phone:
Assistant's Email:

I CAN SPEAK ABOUT (CHECK ALL THAT APPLY):

Account Planning Creative IMC Persuasion
Advertising Process Ethics in Advertising Interactive Political
Branding Gender Portrayals Media Public Service/Non-Profit
Social Responsibility
Ethnic Marketing
Please Specify:
Niche Marketing
Please Specify:
Other
Please Specify:

PLEASE LIST YOUR ALMA MATER(S):

LIST COLLEGES/UNIVERSITIES THAT MEMBERS OF YOUR FAMILY ARE CURRENTLY ATTENDING:

DO YOU HAVE ANY OTHER EDUCATIONAL VISITS PLANNED? IF SO, WHEN & WHERE?

WHERE DO YOU RESIDE (CITY AND STATE)?

IS THERE ANYWHERE YOU TRAVEL FREQUENTLY?

DO YOU HAVE ANY GEOGRAPHICAL PREFERENCES FOR OTHER VISITS?

PLEASE LIST RECOMMENDATIONS FOR ADDITIONAL SPEAKERS, SPECIFICALLY FROM CLIENT COMPANIES. BE SURE TO INCLUDE NAME, TITLE, COMPANY AND ADDRESS.

Recommendation 1
Name:
Title:
Company:
Address:
Recommendation 2
Name:
Title:
Company:
Address:

PLEASE EMAIL YOUR MOST RECENT BIOGRAPHY AND PHOTOGRAPH TO ct@aef.com

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