First Name *

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Tell us About Yourself *

Why are you interested in speaking at the CIA? *

Please upload a high-quality professional photo of you *

Please upload a high-quality professional photo and company logo if applicable

Include your social media handles here: ex @iamdaleearp for Instagram

Please provide some detail on the topic you plan to present and how this will help the CIA community. *

Please give us the format of your presentation, Title, and objectives *

Please feel free to add any other information you feel would be helpful or relevant to your presentation. *

Agreement: If chosen to speak, I give permission to Earp Enterprises to record a video of my presentation at the CIA events. This may be shared on the website, social media or newsletters. In addition, I give Earp Enterprises permission to use my name, photo, video and biography in marketing and promotional materials for CIA events. I understand that my session is not a platform for promotion of my business, practice or conduct. I agree to refrain from political agendas or inappropriate subjects. CIA events are noncommercial forums, the direct promotion of products and services is prohibited. *

We ask that our Speakers help us promote the event through their social media by sharing, engagement and participation. We also may ask to do a Facebook Live, record a video or have you send us a video to generate excitement and interest in the event you will be speaking at. Do you agree to help in these areas? *

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Earp Enterprises is a National Marketing Organization specializing in Life, Health & Medicare products. Agencies and Agents partner with Earp to offer all different insurance products and are not captive to any one particular Insurance Carrier.

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