Awareness Impact & Motivation Specialist www.awarenessims.com awarenessims@gmail.com
Workshop Speaker
Proposal Submission Form
Facilitator's Name (Last, First) *
Your answer
Facilitator's email address *
Your answer
Facilitator's phone number *
Your answer
Name of Organization or College/University *
Your answer
Social Media Links (optional)
Facebook page, Twitter, Linkedin, etc.
Your answer
Title of your proposed workshop (no more than 100 characters count) *
Your answer
Brief description of your proposed workshop (no more than 1000 characters count) *
Your answer
Please list the intended outcomes for the participants of your workshop. *
Your answer
Please provide a brief outline of your workshop. *
Your answer
Have you previously facilitated this workshop? *
Please provide a brief bio for the lead facilitator. (No more than 1000 characters count) *
This bio will be published in the conference materials
Your answer
Co-Facilitator's Name (Last, First)
Your answer
Co-Facilitator's Name (Last, First)
Your answer
Co-Facilitator's Name (Last, First)
Your answer
Are you interested in facilitating your workshop twice during the conference? *
Please select the equipment that you would need for your workshop. *
We will do our best to meet your needs, but will let you know about our ability to fill this request closer to the date of the conference.
Required
Select an area that best fits your workshop. (Please select one) *
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