Speaker Intake Form

Speaker Name*
First Last
Job Title*
Organization Name*
Mobile Phone*
Email*
BIO AND PHOTO
NCSHA will use your bio and photo to promote your participation in this event. Please copy and paste a brief version of your bio into the space provided below.
Upload Photo
Please upload a JPG or PNG file, with a minimum width of 300 pixels. By providing your photograph, you give your consent to the National Council of State Housing Agencies to publish said photograph in NCSHA communications and publications and on NCSHA websites, and to use your full name in connection therewith, to promote your participation in the conference. If you have questions or concerns, please contact NCSHA Director of Marketing and Communications Lisa Bowman at lbowman@ncsha.org.
Accepted file types: jpg, jpeg, png, gif.
Recording Release*
I hereby give my consent for the National Council of State Housing Agencies to record me and to use, reuse, publish, and republish the same, in whole or in part, for any lawful purposes in NCSHA communications, publications, and education and on NCSHA websites, both now and in the future, and to use my full name in connection therewith. I grant my consent voluntarily and understand it will not result in financial compensation. I release the National Council of State Housing Agencies, their contractors, and their employees from liability for any claims by me or any third party in connection with my participation. By signing this release, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby.
- I give my consent.
- I do not give my consent.

Speaker Intake Form

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