2023 Diversity, Equity, and Inclusion Forum

Presenter Name: *

First Name *

Last Name *

Title *

Please type your job title.

Company *

Please type the name of the company you work for.

Email Address *

Please type the best email address to reach you at.

Phone Number *

Please enter the best phone number to reach you at.

Additional Presenters

If you would like to do a group presentation with multiple presentations, please use this space to enter their names, titles, company, and contact information.

Which track would you like to present in? *

Diverse owned or led businesses/diverse entrepreneurs

DEI Workplace Practices

Session Name *

Please put a title for the name of what you would like your session to be called if picked as a presenter. Note: The session name can be adjusted up until marketing materials are released.

Description of presentation *

Please give a description of the presentation you would like us to use to promote your session.

Outline of presentation *

Please give a brief outline of the topics covered during the presentation you would like to give.

Headshot *

Please upload a professional headshot that you agree to let us use in promotional materials if your presentation is accepted.

20MB max

Additional Presenters Headshots

Please upload a professional headshot of any additional presentors that you agree to let us use in promotional materials if your presentation is accepted.

20MB max

Supporting files

Please upload any additional supporting files that you would like to include with your submission. The max file size is 10MB. If you have files larger than 10MB that you would like to include, please email to Everal at everal@wyomingvalleychamber.org.

20MB max

Agreement *

By selecting this option, you agree to let the Greater Wyoming Valley Chamber of Commerce share your submission and everything included within it to the Greater Wyoming Valley Chamber Diversity, Equity, and Inclusion Council. If your submission is accepted, you also agree to allow the Greater Wyoming Valley Chamber of Commerce to use the information within the submission to develop marketing materials to help promote the Diversity, Equity, and Inclusion Webinar Series. By accepting, you also agree to allow the Greater Wyoming Valley Chamber of Commerce to record your session to be posted on the chamber's website and social media channels and allow the Greater Wyoming Valley Chamber to use in future marketing materials.

I agree

Digital Signature *

Please type your first and last name again in place of a signature.

First Name *

Last Name *

Digital Signature Date *

Please select today's date to confirm your adherence to the agreement above.