Speaker Confirmation/Travel Arrangement

Presenter's Information

Name*

First Last

AIA Designation

AIA Member # (If you are not a member of AIA please type "nonmember" in field.)*

Company Name*

Job Title

Address

Street Address City State / Province / Region ZIP / Postal Code

Office Phone

Mobile Phone*

Email*

Travel Information

The most efficient and economical mode of transportation should be utilized. Reimbursement for travel will only be made for the most direct and convenient route from the principal place of residence to and from the meeting. AIR: AIA Arkansas will contact you regarding flight arrangements and will plan for you to arrive the night prior to your speaking date unless otherwise advised. Transportation arrangements to and from the airport to the Hotel / Convention Center will be provided. You will not need a vehicle. AIA Arkansas will provide you with the travel itinerary once it has been set. AUTOMOBILE: AIA Arkansas will reimburse in accordance with the allowable IRS mileage rate. If it is more economical or efficient to travel by air, the reimbursement for automobile costs will not exceed the air costs. Rental costs for an automobile will not be reimbursed.

I will travel to Arkansas by*

Legal Name*

Hotel Accommodations

AIA Arkansas will book and pay for single room accommodation at a designated conference hotel for one (1) night. Any additional nights will be at your own expense.

Speaker Reimbursement

All expense reimbursement requests must be submitted to AIA Arkansas within 15 days of presentation date. All reimbursement requests MUST be accompanied by corresponding receipts. Any expense items not specified above are expressly excluded from reimbursement (i.e., room service, phone calls, laundry, dry cleaning, in-room moves, entertainment, and limousines). Meals during the convention will be provided through convention events. AIA Arkansas will reimburse up to $50 per day for food on the days traveling to and from the convention.

Audiovisual Equipment

Please indicate the types of equipment needed for your session. A projector and rear projection screen will be used for most lectures. Screen size will be based on the type of equipment and room size.

Microphones*

Wireless Lavaliere (Lapel)
Wireless Handheld

images on slides should be no more than 72dpi

I will need a laser pointer.*

Yes
No

I will need a slide advancer.*

Yes
No

I will use my own laptop.*

Yes
No

If you will be using your own laptop, specify type*

MAC
PC

I will use a jump drive and will need a computer*

Yes
No

The jump drive is set up on a*

MAC
PC

Biography & Photo

Please provide a head-shot photo for use in event advertising and the convention program.*

Accepted file types: jpg, jpeg, png, gif.

Your Biography*

Please provide your biography in paragraph form.

Speaker Intro

Please provide a brief speaker introduction to be used when announcing you to our members. If you do not have one or do not wish to provide one, just type "none" in the text box.

Speaker Release Information

Cancellation Policy

AIA Arkansas reserves the right to change or cancel any seminar, session or event associated with Convention. If a schedule change is deemed necessary, Speaker will be notified as soon as the decision is made. AIA Arkansas will make every attempt to replace the program as well as attempt to include Speaker participation in the conference. However, if a replacement program is not possible, AIA Arkansas is not liable for any fees or costs associated with the canceled event. If Speaker has incurred costs which AIA Arkansas has initially agreed to reimburse, Management will reimburse these expenses within 30 days of notice of cancellation. This reimbursement policy will only apply to those expenses in which AIA Arkansas has received receipts and invoices prior to cancellation

Presentation Photography

This release applies only to my presentation and materials delivered at the AIA Arkansas State Convention and no way limits speakers use of materials. Any copyright of speaker presentation and materials shall continue to be speaker's property or that of their company. Speaker's presentation will not infringe any copyright or include any materials that is libelous, scandalous or an invasion of privacy. Please be advised that AIA Arkansas reserves the right to use your name, photography and presentation title in the marketing materials promoting the convention. By approving this agreement the speaker authorizes AIA Arkansas the right to use all such materials as appropriate in connection with the convention, including publicizing the event itself.

By signing this agreement, you certify that you have read, understand and agree to the terms and conditions set forth. My typed name below will be used as my signature.*

I agree
I do not agree