San Antonio's 1st annual MST & PTSD Symposium Speaker/Vendor/Sponsor Request
Please fill out form completely and if you have any questions please reach out to us at circleofarms19@gmail.com.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Military Affiliation
Active Duty
Veteran/Retired
Guard/Reserve
Spouse/Child
Parent of military member
Other
Explain other
Are you requesting to be a vendor or speaker?
Please Select
Speaker
Vendor
Both
Sponsor (scroll to the bottom)
If you're requesting to be a speaker, which area of expertise do you have in the area of MST & PTSD?
Military SART/SARC
Trauma Informed Counselor/Social Worker/Psychologist/Dr
PEER Support with Lived Experience
Clinical Researcher
Victims Advocate
MST Coordinator
LGBQT+ Advocate/Peer
Male MST Advocate/Peer
Other
Do you have a certification or degree in or to support the specific topic? Please write them below
How many years of experience?
Do you require special equipment or audio to speak? If so please write below what you need and we will try to accomodate your request.
Please add any other specific details about your speaking experience and/or platform
This symposium will be held for the first time here in San Antonnio, Tx. We don't have the funding to pay for travel, lodging, or per diem at this time. We respect your time and expertise you're providing to the symposium and our guests. and plan to accomodate transportation to and from the symposium, your meals for the day, and if absolute neccessary provide a place to stay within a home of another veteran.
I understand and can cover my own cost for travel, lodging, and transportation to the symposium. I still would like to participate as a speaker.
I understand and can cover my travel but will need assistance with lodging & transportation. I still would like to participate as a speaker.
I understand and only need assistance with transportation. I still would like to be participate as a speaker.
I'm no longer interested if I'm not getting paid
If you're participating as a vendor, please choose what product or service you will be providing to guests
Holistic Healing such as: essential oil, herbs, plants, etc...
Empowering services such as: training, workshops, retreats, peer groups, etc...
Education resources such as: counseling, financial, claims, healthcare, employment, etc...
Self-care products
Self-love apparel
Book Signing
Outer & Inner Strength such as yoga, exercise coach, meditation, rock climbing, etc...
Other
Explaination of other
Provide more details of your business, product, service, or resource below
Please include any EIN #'s for businesses
Do you need an outlet?
Yes
No
Do you need a table and chair?
Yes
No, I'll bring my own
Are you going to supply free swag materials for guests?
Yes
No
There's a vendor fee which will need to be paid upon registration. The fee for a business is $100 and nonprofit is $50. Thank you!
Yes, I understand and will pay the fee
No, I don't wish to pay to be a vendor
Sponsorship Information: Interested in being a sponsor? Please look at the levels below and select which package you would like more information about. Your sponsorship will help us make our first annual symposium a success! Thank you!
Warrior- $1,000.00 sponsorship level (logo/contact info/website on all marketing material/lunch/vendor table & preferred lunch table x6/ recognition at symposium)
Advocate- $500 sponsorship level (logo/contact info/website on all marketing material/lunch x4/vednor table/recognition at symposium)
Peer- $300 (logo/contact info/website on all marketing material/lunch x2)
Ally- $150 (logo/contact info on symposium brochures/lunch X2)
Use this space for extra details, questions or concerns
My selection
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Business Vendor
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Nonprofit Vendor
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Warrior Sponsor
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Advocate Sponsor
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Peer Sponsor
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300.00
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Ally Sponsor
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150.00
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Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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