Breakout Speaker Form We look forward to hosting you at our Ignite event. Please complete this form to help us better accommodate you. Name * First Name Last Name Email * Phone (###) ### #### Transportation Will you be flying or driving to Charlotte, NC? * Flying Driving If you are flying will you need us to shuttle you back and forth between airport, hotel, and conference center? Yes, I would love for your team to shuttle me throughout the duration of the conference. No, I have arranged my own transportation from the airport and for the duration of conference. If you are flying please provide your arrival and departure date/time. If this information isn't available yet please email us your itinerary once they become available. Email us at events@ignitemvmt.com Accommodations Will you be needing accommodations? * It is understood that you will be responsible for covering accommodations for any additional person you bring with you (with the exception of your spouse) unless Ignite Movement has made a contractual agreement upfront to cover any or all expenses. Yes, I would like Ignite Movement to book my accommodations. No, I have made other arrangements and do not need Ignite Movement to provide accommodations. No, I live in the surrounding area and do not need accommodations. Audio + Visual Needs What kind of mic do you prefer to use? Handheld Headset Will you have any slides, videos, songs, media, pictures, ect. that will be presented during your message? Yes No Product Information Will you be bringing products? Yes No Promotional Information Please provide a Bio to be used for promotional material and introductions. Thank you!