Potential Speaker Interest Form
Thanks for your interest in speaking at Ellevate Foundations' 2024 Women's Leadership Summit. Please complete the info below and we'll be in touch soon!
Speaker Name
First Name
Last Name
Speaker's Organization
Speaker's URL
Speaker's Email
example@example.com
Speaker's Phone Number
Please enter a valid phone number.
Speaker's LinkedIn Profile
Booking Representative (if applicable)
First Name
Last Name
Booking Representative's Email (if applicable)
example@example.com
Booking Representative's Phone Number (if applicable)
Please enter a valid phone number.
Which of the following event themes would you like to be considered for (check all that apply)
Business Leadership
Personal Empowerment
Wellbeing / Self Care
Which of the following format(s) would you like to be considered for (check all that apply)
Keynote (45 minutes)
Workshop (30-45 minutes)
Panelist (45 minutes)
Words of Wisdom (WoW) TED-Style (15 minutes)
Please briefly describe how you would approach this topic and what you envision as key takeaways.
Speaker Bio
Do you typically charge a fee for your speaking engagements?
Yes, and this is non-negotiable
Yes, but willing to waive for this non-profit engagement
No fee for this engagement
Please provide any speaking samples, references or anything else you'd like to share here.
Who can we thank for introducing you to Ellevate?
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