Panelist and Moderator Forms

In 2023 we are making use of three speaker forms as a means of streamlining the process. We need different information from our speakers at different points during the event organization process and we have found using a single form creates a bottleneck and delays in obtaining the necessary information. Thank you for your understanding!

Other forms will appear on this page as we seek additional information from our speakers.

Form 1: APFM 2023 Conference Speaker Agreement

We look forward to having you present at the 2023 APFM Conference! Please complete the below form at your earliest convenience. This form is your confirmation to your role in the conference, as well as time and date of your presentation, as summarized in the email you received from our conference committee members.

APFM 2023 Conference Speaker Agreement
Are you a Solo Presenter, Panel Moderator or Panelist?

Speaker Info

This will be listed on all conference materials.
This will be listed on all conference materials. Please include all designations.
We need a phone number to which we can text you on the day of the session.
0 of 250 max words
Please include your short professional bio - no more than 250 words

Maximum file size: 2MB

Please upload your most current professional headshot (in JPEG or PNG format). If you are unable to upload through this form for any reason, please email your headshot ASAP to: [email protected]

Speaker Agreement

Please confirm your agreement with the statements below.
Participation *
Technology *
Expenses *
Registration *
Notification *
For questions, please contact APFM at [email protected] or 802-823-2566.
Content *


Use of Name and Bio *
Use of Content *
Use of Content for Members *
Understanding *

Questions, please contact:

Kacy Wiant, APFM Administrator
[email protected]

Signature and Agreement Submission


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