ACEI Speakers' Bureau Application

(Please type or print all information. Thank you.)

Today's Date_______________ Social Security # ___________________________

Name _____________________________________ ACEI Membership#___________

Address_______________________________________________________________

Phone numbers: (w)_____________________(fax)______________________________

(h) _______________________(e-mail)_______________________________________

Present Position:

Title______________________________________________________________________

Agency/School_____________________________________________________________

Responsibilities____________________________________________________________

__________________________________________________________________________

Education Background:

__________________________________________________________________________

Professional Experience (related awards, publications, lectures, etc.)

__________________________________________________________________________

Area(s) of expertise on which you speak: (please write in sentence form). Please do not exceed 75 words

__________________________________________________________________________

Past presentations/offices held with ACEI:

__________________________________________________________________________

Nature and size of groups that will benefit from your presentation:

__________________________________________________________________________

City/region you're available for speaking engagements:

__________________________________________________________________________

Signature ____________________________ Date______________________

Important:
Please return this completed form, vitae, and (2) letters of recommendation, with a non-returnable black and white (preferably) photo. If you wish, you can send an electronic photo to aceihq@aol.com. Information from your application will be used to promote the Speakers' Bureau.

Please send the above to:
ACEI, Attn: Speakers Bureau, 17904 Georgia Ave., Suite 215, Olney, MD 20832 USA
301.570.2111 or 1.800.423.3563; Fax 1.301.570.2212; e-mail: aceihq@aol.com

Note: The ACEI Executive Board meets twice a year, in October and in April. The Board determines which applicants are accepted in the Speakers Bureau. Applicants must be a Professional Member of ACEI for a minimum of 3 years. If you are not a current member and wish to join ACEI, please click here to obtain a Membership form.

Return to ACEI home page.

ACEI Speakers' Bureau Application

Last updated December 2004