Fearless VC Summit Speaker Form Please complete this form in its entirety Name * First Name Last Name Email * Company Do you agree to be a speaker? * (Please select one) Yes No Will bring a +1? Yes No Full name and email for +1 (if applicable) Phone * (###) ### #### Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Which day(s) will you be attending? * (Select all that apply) Investor/Founder Day Conference Day Demo Day Do you need to reserve a hotel room? * (More information will follow) Yes No VC Summit gift bag donation * We are asking for our portfolio companies to contribute to our gift bags. We are requesting a minimum of 300 items. Yes, I can donate 300 items to the summit No, I cannot donate to the summit Yes, I can donate but less than 300 (indicate amount in the comment box below) Do you have any questions or comments for our team? Thank you our team will be in touch with further instructions and/or questions.
