Speaker Form
Your Speaker slot is not confirmed until this form is filled out, the agreement is signed, and the interview is booked. Everything you need is in this form.
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Assistant's Name
First Name
Last Name
Assistant's Number
example@example.com
High Resolution Headshot
*
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Speaker Bio: (copy/paste here)
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What is your email list size?
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Include free gift link here.
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Description of free gift
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List any specific topics you'd like to discuss in the interview
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Include a screenshot of your currently subscribed email list number. This is something we require because we want to ensure that we are speaking correctly and with full transparency to our speakers that everyone on board is meeting this requirement. Unfortunately, there have been instances where people say they meet the requirements but then don't, and that just isn't fair to the others who were honest. We trust you understand that this is FOR your good!
*
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The Promotional Period is from Aug 7-23, 2026.
What date will you send your SOLO EMAIL #1?
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Month
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Day
Year
Date
What date will you send your SOLO EMAIL #2?
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Month
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Day
Year
Date
What date will you post to your SOCIAL MEDIA #1?
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Month
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Day
Year
Date
What date will you post to your SOCIAL MEDIA #2?
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Month
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Day
Year
Date
Know 1-3 potential guest speakers we could invite on? We love recommendations.
Fill out your Speaker Agreement Form here and click yes once you've signed: https://www.jotform.com/sign/261635617494061/invite/01kv17ny6n741664981003a252
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Yes
Book your interview with Tilly here and click yes once you're schedule in: https://calendly.com/laceybroussard/shameless-interview-with-tilly-storm
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Yes
Submit
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