Name
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First Name
Last Name
Your Location (country) and Time Zone
Email
*
example@example.com
Phone Number, including country code (for Whatsapp or other messaging )
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Your assistant's name (if applicable)
Assistant's email
Assistant's phone number (for Whatsapp / other messaging)
Please upload your headshot (800 x 800 pixels or larger)
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Please provide the title you'd like to appear below your head shot on the Home page (eg. "Herbalist, Author, International Teacher & Earth Elder")
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Please provide your short bio (250 words or less) that will appear on your Speaker Page
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Please provide your website URL and your top (max 3) social links (full URLs for all socials provided please, eg. https://www.instagram.com/alkhemicaldreaming/)
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Please choose a title / focus for your interview/presentation that lights you up and that you will be excited to share with our audience. If you have any questions about what topic to choose, please contact Clara at clara@alkhemicaldreaming.com
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Please choose if you'd like to do an interview or a visual presentation (with slides or similar)
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Interview
Presentation
Please provide 4 or 5 questions that Clara can ask you during your interview, or the main content points if it's a presentation, that will best highlight your expertise on your chosen topic, and that will allow you to share what you are most passionate about.
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Your Free Gift URL (Type NA if you'd prefer not to include this)
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Your Free Gift Title & Description
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Each speaker is requested to send 2 dedicated emails about the event to your full email subscriber list between 22nd December 2025 and 4th January 2026. Date of first email to your full subscriber list:
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Day
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Month
Year
Date
Date of second dedicated email to your full subscriber list:
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Day
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Month
Year
Date
Please list the total size of your email subscriber list, for tracking & organizational purposes.
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Is there anything else you'd like us to know in advance?
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