GSFE CHINO VALLEY SPEAKER FORM
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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I understand this speaking opportunity is volunteer, I can make connections and promote my business. "My fee is waved for the meeting I am approved to speak at."
I UNDERSTAND
I am a GSFE MEMBER
*
Yes
No
If yes what Chapter
Location / login info will be provided after approval
*
Yes, I Understand
One speaking topic you choose will be selected for the meeting
*
Yes, I Understand
My best speaking topics I can execute
*
My one preferred speaking topic is:
*
I will be using a power point (Optional Not Required)
Yes
No
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My 1st preferred speaking date
*
Please Select
July 7th, 2023 “Hybrid”
August 4th, 2023 (Virtual Only)
September 8th, 2023 (Virtual Only)
October 6th, 2023 “Hybrid”
November 3rd, 2023 “Hybrid”
December 1st, 2023 “Hybrid”
My 2nd preferred speaking date
*
Please Select
July 7th, 2023 “Hybrid”
August 4th, 2023 (Virtual Only)
September 8th, 2023 (Virtual Only)
October 6th, 2023 “Hybrid”
November 3rd, 2023 “Hybrid”
December 1st, 2023 “Hybrid”
If I am not available to speak for any reason, I will notify GSFE Chino Valley ASAP
*
Yes I Will
I give permission for GSFE to use any photo of me or video taken for marketing purposes of the flyer / events
*
Yes
Upload Clear Speaker Photo
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload Clear Back Up Speaker Photo
*
Browse Files
Drag and drop files here
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of
COPY AND PASTE YOUR SHORT BIO FOR THE FLYER
*
Signature
*
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