Speaker Form
Name: *
Your answer
Cell phone number: *
Your answer
I have a speech impairment, can I text this number if needed? *
Email: *
Your answer
Website:
Your answer
Facebook:
Your answer
Instagram:
Your answer
Are you applying for a specific date? If so, what date?
MM
/
DD
/
YYYY
Would you like to hear about future opportunities? *
If yes, how far within Ontario will you be willing to travel?
Your answer
Paid or volunteer? *
If 2, what are your rates?
Your answer
Tell me a bit about what you want to speak about. More details, the better. If you're not sure yet, feel free to skip this question.
Your answer
How long would you like to speak for? If you're not sure yet, feel free to skip this question.
Your answer
Any previous speaking experience? (Not required)
Your answer
You will post about this event on social media and tell your friends and family. *
Avoid saying things that would generally offend or trigger others. *
Other notes or questions?
Your answer
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