Panel Submission Form

Name*

First Last

Primary Email*

Enter Email Confirm Email

Display Name

How would you like to be listed publicly if different from above?

Short Bio*

3rd person, 500 characters or less

Twitter Handle*

Website

Phone

Are you willing to be interviewed by members of the press?*

If you would prefer not to be interviewed, this will not impact whether your panel is selected; we ask this question to facilitate scheduling interviews.

Yes, I am willing
No, I would rather not

Are you interested in participating as a mentor in our speed-networking event?*

The speed-networking event provides an opportunity for young women to connect and speak with professional women in STEAM fields such as comic book creation, writing and editing, game development and programming, medicine, and more. Please let us know if you are interested and we will contact you with further details.

Yes
No

Any additional information about yourself that you would like to add?

Panel Title*

What is the title of your panel? Please select something concise, and which accurately reflects the content you will be discussing.

Panel Description*

What will you be discussing? 500 characters or less

Panel Format*

If you selected "Other," please describe the format.

Panel Tags*

What keywords would you use to categorize/describe your panel?

Examples might include "gaming," "pop culture criticism," "writing," "cosplay," "skill-building," or "social justice."

How would your participation as a panelist or moderator help to support our Mission Values, in particular those regarding diversity and inclusion?*

At GeekGirlCon, diversity, inclusion, and intersectionality are incredibly important. How does your panel contribute to a culture of inclusion and diversity? You can view our Mission and Values here.

Content Rating*

What age/maturity level is this panel intended for?

Are you willing to make modifications to this panel?*

Sometimes we request changes be made in order for panels to be presented at GeekGirlCon. Changes might include altering the title, adding panelists, or shifting the panel focus slightly.

Yes, absolutely
No, I'd rather not
Maybe

Do you have special A/V or equipment needs?

Each panel room will be equipped with a projector and screen, and microphones. You will need to bring your own laptop and any necessary adapters to connect via HDMI. Wi-Fi in the Conference Center is not always reliable, so please save your presentation materials to your computer/a flash drive.

We will do our best to accommodate special A/V and equipment requests, but we cannot make any guarantees.

Use the "+" to the right of the text box to add more items to the list.

Panel Materials

If you happen to already have panel materials prepared, please link to them here.

Panel materials might include a list of questions or discussion topics, PowerPoint slides, or sources/references.

Having these materials prepared in advance will not increase or decrease your chances of having your panel selected - it is simply one additional way we are able to review the panel content.

Do you have co-panelists?

Yes, and I do not need any more
Yes, but I would like you to help me find more
Yes, but I need to find more on my own
No, and I do not want any
No, and I would like you to help me find some
No, I need to find some on my own

Are there any special accommodations that we should provide for you or your panelists?*

Yes
No

Are you the panel moderator?*

Yes, I am the moderator
No, someone else is the moderator
No, it has no moderator

Who is the moderator?

How many co-panelists do you currently have confirmed?*

Co-Panelist #1

Name*

First Last

Email*

Display Name

How would they like to be listed publicly if different from above?

Phone

Short Bio*

3rd person, 500 characters or less

Twitter Handle

Website

Is this panelist willing to be interviewed by a member of the press?*

Yes, they are willing
No, they would rather not

Co-Panelist #2

Name*

First Last

Email*

Display Name

How would they like to be listed publicly if different from above?

Phone

Short Bio*

3rd person, 500 characters or less

Twitter Handle

Website

Is this panelist willing to be interviewed by a member of the press?*

Yes, they are willing
No, they would rather not

Co-Panelist #3

Name*

First Last

Email*

Display Name

How would they like to be listed publicly if different from above?

Phone

Short Bio*

3rd person, 500 characters or less

Twitter Handle

Website

Is this panelist willing to be interviewed by a member of the press?*

Yes, they are willing
No, they would rather not

Co-Panelist #4

Name*

First Last

Email*

Display Name

How would they like to be listed publicly if different from above?

Phone

Short Bio*

3rd person, 500 characters or less

Twitter Handle

Website

Is this panelist willing to be interviewed by a member of the press?*

Yes, they are willing
No, they would rather not

Co-Panelist #5

Name*

First Last

Email*

Display Name

How would they like to be listed publicly if different from above?

Phone

Short Bio*

3rd person, 500 characters or less

Twitter Handle

Website

Is this panelist willing to be interviewed by a member of the press?*

Yes, they are willing
No, they would rather not

Is this panel complete at the time of submission?*

That is to say, do you have a title and description and all participants?

Yes, this panel submission is complete!
No, I am still working on a few things
No, there is still a lot of work to do

Do you or any of your panelists have schedule conflicts?*

Is there any day/time that your panel CANNOT be scheduled?

Demographics questionnaire

The questions below do not increase or decrease the likelihood of your participation.

How did you hear about us? If a staff member referred you please let us know.*

I identify my ethnicity as:

Asian
Black/African
Caucasian
Hispanic/Latinx
Native American
Middle Eastern
Pacific Islander
Other

My gender is:

Female
Male
Non-binary
Other

Do you identify as transgender?

Yes
No

Programming Submissions