Speaker Application
Thank you for applying to speak at the Ending Clinician Burnout 2025 Virtual Summit: where our mission is to share success and celebrate communities. Please fill out the form below to the best of your ability- if you need to leave something blank, you will be able to edit the form later. If you have questions please e-mail admin@endingclinicianburnout.org
Select which events you want to use this talk for. (Please resubmit for each new topic)
Virtual Summit
In-Person Retreat
Name- as you want it to appear on all materials
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First Name
Last Name
Your Title as you want it to appear on all marketing materials.
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Example: Profitability Expert.
Email- that you want attendees to contact you at
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example@example.com
Phone Number
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Area Code
Phone Number
Would you like to help with other aspects of the event? Please select all that apply
Sharing online
Sharing event with healthcare organizations
Being an event ambassador
Sponsoring the event
Providing materials or "swag" for attendees
Donating services (marketing, video editing, images)
If you have a one sheet for your talk, you can upload it here.
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Please provide your bio for our website.
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Please upload a headshot.
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What is your topic of choice or the title of your talk?
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If you have an uploadable file with your talking points please upload it here
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Please provide 3 bullet points that describe what attendees will learn from your talk.
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Do you have a lead magnet, give-away or downloadable? If so please put the URL here. Please use an affiliate link so that you can easily track leads from our summit.
Are you planning to provide a product or coaching offer? Please use an affiliate link so that you can easily track leads from our summit. We ask that you make a nonprofit donation for any sales.
Anything else you need us to know?
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