Speaker Application:
Tell us about you!
*
First & Last Name
Business Name
Phone Number
*
Email
*
example@example.com
Website
Social Media Handle
Ex. Instagram, Twitter, Facebook
Are you a Polka Dot Power House Member?
*
Please Select
Yes - Worcester Chapter
Yes - Visiting member
No - Would love to join
No - Not interested in joining
Have you attended a Polka Dots Meeting before?
*
Please Select
Yes
No
Visiting Sister - Which Chapter are you visiting from?
*
How did you hear about this speaker opportunity?
*
Short Biography:
*
Summarize your presentation:
*
Submit
Should be Empty: