CO+HOOTS In-Person Speaker Application

1
Full Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Organization / Company* This field is required.
5
LinkedIn* This field is required.Ex. https://www.linkedin.com/in/jmunoz-speaks/
6
IG or other Socials* This field is required.Include whichever account(s) you want us to tag you in. (Ex. @cohootsphx or @jaimeemunozz If you do not wish to share your socials, please input "None"
7
What gender do you identify as?
Female
Male
Non-binary/Third gender
Prefer not to say
8
How do you describe your ethnicity?* This field is required.
Hispanic, Latino or Spanish Origin
Native American or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Don't wish to answer
9
Do you speak any of the following languages:* This field is required.
Chinese (Medium)
Chinese (Cantonese)
Vietnamese
Spanish
Korean
None
Other
10
BIO* This field is required.2-3 Sentences or Short Paragraph about your experience & expertise.
11
Upload your headshot* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
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Choose your area of expertise:* This field is required.
Business Strategy
Finance
HR
Legal
Marketing & Sales
Operations
Product & Service Development
Web & Tech
Other
13
Years of experience with this area of expertise:* This field is required.
Under a year
1-2 years
3-5 years
6-10 years
10-19 years
More than 20 years
Other
14
How much would you normally charge for your services per hour?* This field is required.
$25 - $49
$50 - $99
$100 - $149
$150 - $199
$200 - $499
$500+
Other
15
Which CO+HOOTS location would you like to speak?* This field is required.
Phoenix
Mesa
16
Title for your speaking session:* This field is required.Try to be witty, clever titles do the best! Ex. 5 steps to grow your business, Sales tips from pros, How to operationalize your life, How to Destroy Your To Do List)
17
Abstract:Give us two to three paragraphs max about what an attendee will learn. Make it as specific as possible
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What are three key things the audience will be able to do after attending your session?What are three key things the audience will be able to do after attending your session?
19
Would you like to sponsor lunch for this event?
Please Select
Please Select
Yes
No
20
Terms and Conditions* This field is required.
21
Terms and Conditions* This field is required.
Should be Empty: