Teacher Application for #BlogWell Retreats
Thank you for your interest in presenting at one of our events. Please fill out the form and one of our team members will be in touch shortly.

Blog Well Retreats, Blogging Successfully and our sponsors will not be providing compensation, covering transportation, lodging or meals outside of meals that are provided to attendees.

Your Name *
Your answer
Which Retreat are you applying for? *
Your answer
Your Email *
Your answer
Your phone number *
Your answer
Your Mailing Address *
Your answer
Your Website URL *
Your answer
URL of your speaking page or best example video of speaking/presenting to a group *
Your answer
URL of your professional speaker headshot *
Your answer
Short Bio (40 words or less) *
Your answer
Long Bio (up to 150 words) *
Your answer
Please list other professional events where you have served as a speaker/teacher *
Your answer
Twitter URL: *
Your answer
Pinterest URL: *
Your answer
Instagram URL: *
Your answer
Facebook Page URL: *
Your answer
Facebook Group URL: (If you have one)
Your answer
LinkedIn URL:
Your answer
Other Social Media:
Your answer
Your Reach (total social media following + blog pageviews for 1 month) *
Your answer
Number of Email Subscribers *
Your answer
Proposed Presentation Title (45-60 min session) *
Your answer
Presentation Summary, including 3 main points and implementation actions attendees can make. *
Your answer
Do you require any special equipment for your presentation? *
Your answer
Where else have you presented this topic? and when? *
Your answer
You consider your content to be for... *
We expect speakers to prepare a handout for notes, resources, homework, next steps, etc. If you want #BlogWell Retreats to print these the PDFs must be submitted no later than 30 days prior to the event. *
Explain your motivation for applying to speak at #BlogWell Retreats *
Your answer
Would you like to submit an item for the attendee gift bags? *
Please describe your item/offer *
Your answer
Are you willing and able to be present for the entire event, and willing to assist attendees as needed during the afternoon work time and VIP small group times? *
Do you agree to allow #BlogWell Retreats and Blogging Successfully to use your name and likeness in promotion of our events? *
Please provide the name and contact information for a reference, preferably an event organizer for whom you've given a presentation. *
Your answer
If selected, are you willing to promote Blog Well Retreats to your email list and followers?
Your answer
Is there anything else you'd like us to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.