SPECIAL GUEST SPEAKER FORM
Changing lives with your mission and message.
Registering as:
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MIC Guest Speaker (First Time)
MIC Guest Speaker (Returning)
Guest Speaker on The Best Show
Guest Speaker at Business Empowered Chamber Luncheon
If Other, please submit the name of the event you are speaking for.
Confirmed Date of Appearance
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Month
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Day
Year
Date
Full Name
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First Name
Last Name
E-mail
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Phone Number
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Area Code
Phone Number
Website
Social Media Handles
Name of Your Business/Event
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Brief description in 3 sentences what you’re sharing. (Special Event Only)
Short Bio (no more than 150 words or less)
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Upload Short Bio (150 words or less)
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Please upload a professional headshot for our promo flyer.
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FOR MIC NIGHT GLOBAL OR BEST SHOW GUESTS ONLY
ALL OTHER SPEAKERS CAN SKIP DOWN AND PRESS SUBMIT
FOR MIC NIGHT GLOBAL SPEAKERS ONLY. Video Imaging Checklist: Check All That Apply
I do have access to Zoom.
I do have adequate lighting for your video presentation.
I do have an adequate background with no noise and no clutter.
I am available to do a video-imaging analysis 1 hour before the broadcast.
Do you need us to “Share Screen?”
Yes
No
Networking Agreement
I agree to share the MIC Night Global Networking event with others as a courtesy of inviting me as your guest and/or to share my products or services. The website is www.bemississippi.com and www.facebook.com/BEMississippi on Facebook.
I agree to complete a brief survey after the event. I understand that the survey will be used to better serve the participants and viewers of this event.
For MIC NIGHT GLOBAL NETWORKING PLATFORM SPEAKERS: I agree to share my business services, products and/or upcoming events in the time frame of 5 minutes or less. I understand that going over my limit infringes on the time of the other speakers sharing the platform.
SUBMIT
Should be Empty: