Are you a member of the Women in Retail Leadership Circle?*

Have you attended a previous Women in Retail Leadership Summit?*

Are you recommending yourself or another speaker?*

Speakers Full Name*

Speaker's Title*

Speaker's Company*

Speaker's Website*

Speaker's Email Address*

Speaker's Contact Number 1*

Speaker's Contact Number 2

Speaker's Preferred Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Speaker

Speaker - Other Type

What subject matters would the speaker address?

Potential title of session:

Topic abstract (maximum 200 words)

How long would the session you're pitching take?

Links to videos of previous conference presentations (if available)

Why are you or the recommended speaker passionate about speaking at Women in Retail Leadership Summit, and why do you think you would be a good fit for the audience?

Link to personal website and/or blog

Twitter profile link

Facebook profile link

LinkedIn profile link

Apply to Speak