MetroWest PDP Speaker Application form

Primary Speaker's Name*

First NameLast Name

Your business name. If not applicable place a N/A in the box.*

Your Polka Dot Chapter. *

How long have you been a Dot? *

City*

State*

Your Web Site

Your Industry*

Best Way to Communicate with You*

Can you do both lunch and dinner meetings, and what are your preferred months to talk?

Phone Number*

Area CodePhone Number

E-mail*

The title of your presentation is the first impression for our PDP group and will be on our public facebook page for our guests. Use a concise, but inclusive, title which clearly conveys what you will be presenting and draws attention to your topic.

Title of Your Presentation:*

Why are you passionate about this topic?*

Introductory Bio (to be read prior to your presentation- 250 words or less)*

Brief description/overview of your presentation.*

1-5 Takeaways for our members and guests*

Please provide a photo(s) for PDP promotion (insert file link)

Browse Files

Have you given this presentation before and/or you do you intend to present it elsewhere in the near future?*

Facebook Pages (personal and/or professional)*

Please promote your speaking dates and times via your social media platforms. We will cross promote on our PDP platforms.

I agree to submit my presentation prior to the meeting date*

I understand I will need to read and sign the PDP Media Release form and the Speaker Agreement (see following pages)*

I have verfied that all information provided is accurate. and complete*

Yes