Request to become a volunteer closing guest speaker
Closing guest speaker request
Date *
MM
/
DD
/
YYYY
First Name *
Your answer
Middle Name *
Your answer
Last Name *
Your answer
Phone number *
Your answer
Email *
Your answer
Employer *
Your answer
Profession *
Your answer
Are you willing to come and preview a monthly Change One meeting prior to being granted permission to being our closing guest speaker: *
Have you ever been arrested as an adult: *
If you have ever been arrested and convicted, we ask that you consider and complete the volunteer monthly speaker questionnaire in the forms section to become a Real Talk member. We only allow closing volunteer speakers to present to our participants if you have NOT been arrested and convicted of a crime. *
If you answered no to the previous question, please provide us your reason for requesting to become a closing guest speaker. *
Your answer
Thank you for completing the pre-screening process for proposed closing speakers. A Real Talk staff member will be in contact with you soon. Feel free to provide any additional information below for our viewing.
Your answer
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