Own Your Difference Summit Speaker Interest Form
Please complete all the information below and submit.
Speaker Contact & Professional Background
Full Name
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First Name
Last Name
Business Name or Organization
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Email Address
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example@example.com
Social Media Handles + Website
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High Resolution Headshot
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Short Bio (150–200 words)
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Approximate audience size / email list size
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Identity, Topic & Session Proposal
Do you identify as neurodivergent, work with neurodivergent individuals, or advocate within the neurodivergent community?
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I identify as neurodivergent
I support/work with neurodivergent individuals
I advocate within the neurodivergent community
I am the family member or have a neurodivergent loved one
What topic would you like to speak about?
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Short description of your proposed talk or workshop
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What transformation or outcome will attendees gain from your session?
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Which category best fits your presentation?
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Please Select
Mental Health & Emotional Wellbeing
Autism Awareness
ADHD Support
Entrepreneurship & Neurodiversity
Relationships & Communication
Education & Learning
Workplace Inclusion
Self-Advocacy
Other
Speaking Experience, Promotion & Support
Have you spoken at virtual summits, podcasts, workshops, or events before?
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Yes, frequently
A few times
This would be my first speaking opportunity
Links to previous speaking samples or media appearances
Are you willing to help promote the summit to your audience?
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Yes
No
What accommodations or support would help you feel comfortable and successful as a speaker?
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Why do you feel called to contribute to this neurodivergent summit?
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Would you be willing to schedule a short interview call to determine fit?
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Yes I accept
No I do not accept
Available Opportunities
Which ones are you interested in?
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Speaking only
Panel discussions
Workshops
Networking sessions
Collaborative sessions
Would you be open to contributing a free resource, lead magnet, or bonus gift for attendees?
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Yes
No
By checking this box, I understand that selected speakers are asked to contribute a nominal participation fee to help support the event.
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Yes
Submit
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