Speaker Application Form
Thank you for taking a moment to submit an application to speak to the Worcester MA Chapter. We are a group of women that are dedicated to professional and personal growth. We are a community of respectful, compassionate and mindful women that believe in honesty and integrity. We believe in collaboration and supporting each other with education and empowerment. We are looking for presenters that can speak across the gamete to elevate all areas of lives, from being better women, to better business owners and taking care of ourselves. If you know you can help us become powerhouses in the world, we would love for you to bring your talents & skills to our chapter. We will review your application and be in touch soon.
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
Are you a member of Polka Dot Powerhouse
Yes
No
If Yes, what chapter are you a member of?
If you are a visiting member, would you travel to speak in person to our chapter?
Have you attended a Polka Dot Powerhouse Meeting before?
Yes
No
How did you hear about this speaking opportunity?
Tell Us about You & Your Presentation
Please provide more insight on your business (If you have one) and what the passion is you wish to educate our members on.
Your Business / Organization
Website
Social Media Handles
Title of Your Talk
Please provide a description of the topic you plan to present on & Please share 3 take aways the audience should expect to gain from your presentation. This will be used to write up & promote your presentation.
Please provide a brief bio to introduce you at the meeting:
Please specify if you need anything for the presentation?
Additional Notes
Please Upload a Headshot of You
If selected to be a speaker, it is expected that you will:
Promote meetings you speak at
Invite at least 5 guests to attend
You will not sell from the stage. This is for education, not personal promotion.
Signature
Continue
Continue
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