Women in Security Forum Speaker Request Form Step 1 of 4 25% Name of Event:* Organization Hosting the Event:* Purpose of the Event:* Date of Event:* MM slash DD slash YYYY Location:* Street Address Address Line 2 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 Event website/link (or your website if event is not yet being promoted):* Please enter your contact information below so we can contact you about your request.Name* First Last Email* Phone*Topic:* Speaker’s potential role (check all that apply):* Keynote Panelist Moderator Sole presenter Desired Speaker (if known): Does your event pay speaker fees/honorariums?* Yes No Please select preferred speaker areas of expertise: [At least one required, can select multiple]*Markets:* Commercial and facilities Critical infrastructure Education Government and homeland security Health care Public safety Residential Retail Transportation Solutions:* Access control Alarms Artificial intelligence Monitoring Drones and robotics Biometrics Facial recognition Identity management Cloud solutions Internet of Things Cybersecurity Data storage and management Data privacy Integrated systems Life safety Mass notification Perimeter security Video surveillance Video analytics Video management systems Visitor management Security industry standards Workforce development Diversity and inclusion Advocacy and policy impacting the security industry (please specify) Other area of expertise needed Please specify key issues of interest in the comments area below.*Other*Business background of speaker (if applicable) Distributor Security practitioner (e.g., security director) Government official or employee Integrator/dealer/installing firm Investment firm/private equity firm Manufacturer Manufacturer’s representative Marketing/communications firm Nonprofit Research firm/analyst firm Security consultant/A&E firm Service provider Other Other:* {all_fields} Δ
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