First Name *

Middle Name

Last Name *

Professional Designations Held LUTCF
FSS
RHU
CLU
ChFC
CFP
Other

Other

NAIFA-Texas Local Assocation NAIFA-Abilene NAIFA-Amarillo NAIFA-Austin NAIFA-Beaumont NAIFA-Central Texas NAIFA-Corpus Christi NAIFA-Dallas NAIFA-El Paso NAIFA-Fort Worth NAIFA-Great Southwest NAIFA-Greater East Texas NAIFA-Houston NAIFA-Lubbock NAIFA-Mainland NAIFA-Pineywoods NAIFA-Plainview NAIFA-San Angelo NAIFA-San Antonio NAIFA-South Texas NAIFA-Texoma NAIFA-TX Gulf Coast NAIFA-Upper Valley NAIFA-Waco NAIFA-West Texas NAIFA-Wichita Falls *

Other Professional Memberships AHIA
GAMA
MDRT
AALU
SFSP
NAILBA
Other

Practice Specialty Life Insurance & Annuities
Health Insurance & Employee Benefits
Multi-Line Insurance
Financial Advising & Investments
Other

Name of Firm *

Address *

City *

State *

Zip Code *

Your Title *

Phone *

Email *

Website

Fax

Please indicate the appropriate categories for your presentation Leadership
Management
Communication
Technology
Marketing
Customer Service
Advocacy
Sales Ideas
Ethics
Compliance
Prospecting
Counseling
Life Insurance
Health Insurance
Financial Advising
Employee Benefits
Annuities
Properties/Casualty
Business Planning
Estate Planning
Retirement Planning
Asset Allocation
Trusts
Other
*

Presentation Title *

Summary Description *

Learning Objectives 1. 2. *

Presentation Length (minutes) *

Audio/Visual Requirements LCD Projector
Overhead Projector
Screen
Laptop Computer
DVD Player
Lavaliere
Flip Chart
Other

Is your presentation approved for continuing education credits in Texas? Yes No *

Are you willing to travel? Yes No *

How many miles are you willing to travel outside of your local association?

What travel expenses will you expect to be reimbursed for? *

Additional Requirements

Please provide a brief description (50-75 words) of your professional experience, education, & association activities: *

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The NAIFA-Texas Speakers Bureau (NTXSB) is a service for the sole purpose of informing local associations about listed speakers.  Use of the NTXSB for any other purpose is strictly prohibited. Speakers participating in the NTXSB acknowledge and agree that NAIFA shall treat the information such speakers submit to the NTXSB as non-confidential and that NAIFA-Texas may use such information royalty-free in any manner consistent with the purposes of the NTXSB.  NAIFA-Texas is not an agent for or an employer of any speaker listed on the NTXSB, or an agent for any association seeking the services of a speaker listed in the NTXSB.

NAIFA-Texas shall have no involvement in, no control over and no responsibility or liability for, any communications, arrangements or transactions between speakers listed in the NTXSB and local associations that seek to retain such speakers’ services, or that otherwise result from use of the NTXSB.  Any communications, arrangements and transactions between speakers listed in the NTXSB and those local associations that seek to retain such speakers’ services shall be solely the responsibility of such speakers and those seeking to retain the speakers’ services.

NAIFA-Texas does not control, review, verify, screen or endorse, and NAIFA-Texas does not assume any responsibility or liability in connection with, the content of any speech or presentation that may be given as a result of use of the NTXSB or the content of any publication or other media a speaker may offer or present.  The ideas, materials and information presented by speakers listed in the NTXSB do not necessarily reflect the views of NAIFA-Texas.  NAIFA-Texas disclaims all liability for any claims or damages that may result from use of the NTXSB, from any communication or transaction that may result from use of the NTXSB, or from any presentation that may, or may not, be given as a result of use of the NTXSB.

All those who use the NAIFA-Texas Speakers Bureau agree to indemnify, defend and hold NAIFA-Texas harmless from any and all claims arising from such use. Local associations, and not NAIFA-Texas, are responsible for assessing the qualifications of a desired speaker and for providing any compensation that is requested by the speaker and agreed to by the local association.

I hereby authorize verification of the information provided on this form.  If accepted into the NAIFA-Texas Speakers Bureau, I agree to abide by the Rules and Regulations as stipulated in this application.

Agree *