Smart Wellness Retreat Speaker Proposal

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In order to be a speaker at the Smart Wellness Retreat you must complete all questions in the form..
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Name* This field is required.Please provide your name or how you would like the hosts to refer to you as.
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Email* This field is required.Please provide your email address
example@example.com
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Phone Number* This field is required.Please provide your most reliable contact number
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Are you able to receive text reminders?* This field is required.Please confirm if you are able to receive SMS reminders
Yes
No
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Gender* This field is required.Which gender are you?
Male
Female
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Ethnicity* This field is required.Please select which ethnic group(s) you belong to.
Black/African American
Caucasian
Native American
Asian/Pacific Islander
Latin Americian/Hispanic
Other
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Generation* This field is required.Select which generation based off the birth year you belong to
Alpha (2011 & Up)
GenZ (1995-2012)
Millennial (1980-1994)
Gen X (1965-1979)
Baby Boomer (1946-1964)
Silent (1925-1945)
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Are you an entrepreneur or business owner?* This field is required.Are you self-employed or interested in making a transition to this lifestyle?
Yes
No
Thinking about it
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What industry do you work in?* This field is required.Select the best choice(s) for your field of expertise
Accounting
Advertising
Arts, Media & Entertainment
Automotive
Construction
Education
Finance
Food & Beverage
Government
Healthcare
Hospitality
Information Technology
Insurance
Law
Marketing
Medical
Non-Profit
Public Service
Sales
Transportation
Real Estate/Housing
Retail
Printing & Publishing
User Experience
Utilities
Waste Management
Other
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Are you available to attend the 2024 Smart Wellness Retreat?* This field is required.Are you able to attend all days of the Retreat from August 7th-13th?
Yes
No
Thinking about it
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Have you ever spoken at a conference or summit before?* This field is required.Will this be your first time speaking at a live conference, workshop or retreat audience in person?
Yes
No
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Please provide a link to your media kit or content channel* This field is required.Examples of this are media kits, Youtube Channel, podcast, speakers portfolio, or digital brand or content
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If selected as a guest speaker, what subject or topic would you want to discuss?* This field is required.Please provide a brief summary of your 35min speaking subject and title.
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What are your session objectives?* This field is required.Please provide 3-5 objectives for your workshop session.
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Are you an active user on any social media platforms? (By active meaning that you post daily/weekly)* This field is required.Do you actively utilize social media?
Facebook
Instagram
Tiktok
Linkedin
Twitter
Other
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What type of influencer are you?* This field is required.Choose 1 category based off your top used social media site
Less than 1,000 followers
Nano-influencer: 1,000-10,000 followers
Micro-influencer: 10,000-50,000 followers
Mid-tier influencer: 50,000-500,000 followers
Macro-influencer: 500,000-1,000,000 followers
Mega-influencer: 1,000,000+ followers
Other
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Please list any social media handles you use* This field is required.Examples of this are Youtube, Tiktok, Facebook, Instagram, Linkedin, etc.
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Please upload a photo* This field is required.Please upload a profile picture of yourself, preferably a professional headshot. This photo will only be used to promote your flyer on all associated media platforms. Note: After you choose your image, select "Please Upload Image" again before moving to the next screen.
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Terms and Conditions* This field is required.Please check this box to show your viewing and approval of our terms and conditions.
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😄

Thank You for signing up to be a guest speaker at our Smart Wellness Retreat {name}!

Your submission has been received! THANK YOU for working with the Smart Wellness Retreat, we look forward to partnering with you and/or your business. Now that you've taken the first step, please keep a lookout for a mandatory speakers Q&A session introduction that will be sent via email. A Retreat representative will review your proposal and contact you within 5-10 business days to confirm the Retreat details and speaker requirements. Keep shining bright like the bright diamond jewel you were created to be and we look forward to potentially working with you soon!💎💎💎
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