REQUESTFORPROPOSALSforPROFESSIONALCONFERENCESPEAKERS

PROPOSALINFORMATIONSHEETPleasecompletethisproposalinformationsheetandsubmitasignedcopywithyourproposalpackage.YourproposalpackageshouldincludetheinformationrequestedinSectionV,itemsBthroughG.

ProposedPresenterInformation

Name________________________________________________________________________________

Title(ifapplicable) _____________________________________________________________________

CompanyorOrganization(ifapplicable)____________________________________________________

EmailAddress_________________________________________________________________________

MailingAddress _______________________________________________________________________

City ___________________________________ State ________________ ZIP__________________

Isthis home work other(pleasespecify)_________________________________________

Daytimephonenumber______________________ Mobilephonenumber______________________ProposalPreparerInformationIfthisproposalispreparedbysomeoneotherthantheproposedpresenter,pleaseprovidehis/hercontactinformationbelow.Otherwise,leavethissectionblank.

PreparerName________________________________________________________________________

EmailAddress_________________________________________________________________________

Daytimephonenumber______________________ Mobilephonenumber______________________

StatementofUnderstandingBysigningthisproposalinformationsheet,IacknowledgethatifmyproposalisacceptedbytheVirginiaSHRMStateConferenceProgramCommittee,IwillprovideprofessionalconferencespeakingservicesprobonopublicoorasotherwisespecifiedinthisproposalforthegoodoftheHumanResourcesManagementprofessionandinsupportofthegoalsandobjectivesoftheConference.IagreetoindemnifyandholdVIRGINIASHRMSTATECOUNCILharmlessfromanyliabilityandagreetorefrainfromusinganyportionofmypresentationasaplatformtopromoteproductsorservices.

__________________________________________ ________________________________________SignatureofProposedPresenter Date