Speaker Application Form
Thank you for taking a moment to submit an application to speak to the Worcester Chapter. We are a group of women that are dedicated to professional and personal growth. We are a community of respectful, compassionate and mindful women that believe in honesty and integrity. We believe in collaboration and supporting each other with education and empowerment. We are looking for presenters that can speak across the gamete to elevate all areas of lives from being better women, to better business owners and taking care of ourselves. If you know you can help us become powerhouses in our worlds, we would love for you to bring your talents and skills to our chapter. We will review your application, and be in touch with you soon.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you a Polka Dot Powerhouse Member?
Lütfen Seçin
Yes
No
* If yes- What Chapter are you part of?
If you are a visiting member, Would you travel to speak in person to our chapter?
Have you attended a Polka Dot Powerhouse meeting before?
How did you hear about this speaking opportunity?
Tell Us About You & You Presentation
Please provide more insight on your business (if you have one) and what the passion is you wish to educate our members on.
Your Business /Organization
Website
Social Media Handles
Please provide a short bio paragraph, with which we can introduce you at the meeting. This should talk about you, what you do, who you are, what you love... It should give a little insight to the beautiful woman you are, It should not describe your presentation.
Title of Your Speech
Please provide a description of the topic you plan to present on.
Please provide a short paragraph about the topic you will be speaking on and take aways the audiance should expect to gain from your presentation. This will be used to write up and promote your presentation.
Please specify if you need anything for the presentation
Additional Notes
Speaker Guidelines:
Speakers will be considered on an ongoing basis depending on the needs and direction of the members. You are not required to be a Polka Dot Powerhouse member to be considered as a speaker. Polka Dot Powerhouse Membership will give you priority over non-members. Polka DotPowerhouse welcomes non-members to one meeting as a guest. If you have been aGuest Speaker at any Polka Dot Powerhouse chapter within the last year, you will not be considered until you have acquired a membership with Polka DotPowerhouse. Once you are member, you must be an active member to speak to the chapter. I Understand That If Chosen, I will not be able to sell products or services "from the stage" or during the presentation. I will have the opportunity to offer free resources to the audience for those that opted-in. That this application does not guarantee a spot as a speaker for Polka DotPowerhouse-Worcester MA. That if chosen, my topic will be relevant to all women in the room, not just a specific industry or be seen as non-inclusive. If you are considered, the Speaker Coordinator or Managing Director will contact you for a brief chat to ensure you are the right fit for our members.
Signature
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