Become a Speaker or Musician

Become a Speaker or Musician

Complete the following information to be evaluated by our leadership team to become an official Speaker or Musician. Please note in completing this form, you understand and agree that TBTNF and/or its affiliates or designees may use your submission and data as part of its aggregate reporting, operations, and internal review. We do not sell your personal data or contact information to any 3rd parties.
Personal Information
First Name*
M.I.
Last Name*
Street Address*
Apartment / Unit #
City*
State*
ZIP / Postal Code*
Country*
Cell Phone (US Country Code = +1; Canada Country Code = +1; Australia Country Code = +61; UK Country Code = +44; find other Country Codes at https://countrycode.org/)*

Country CodeArea CodePhone Number
Email*

Confirmation Emailexample@example.com
Are you applying to be a TBTN Speaker/Presenter or Musician?*

Speaker/PresenterMusician
Demographics

This information is needed for our non-profit status and other metrics, including those established by grants, governmental agencies, and other NGOs.
My preferred pronouns are:*

She/herHe/himThey/themZe/zem
I identify as:*

FemaleMaleNon-binaryTransgenderI prefer not to say
I identify as:*

Black or AfricanHispanic or LatinoWhiteAsianAmerican IndianPacific IslanderTwo or more racesUnknownI prefer not to say
I identify as:*

Heterosexual/StraightGay or LesbianBisexualPansexualI prefer not to say
My age is:*
Have you had your COVID vaccination and if so which is the most accurate description of your status? Only select answers that start with "Yes" if you have your VACCINE card that you could physically present before entering a school or business. This information is required by some of our venues.

Yes, I have had at least 3 COVID vaccinations.Yes, I have had 2 COVID vaccinations.Yes, but I have had only 1 COVID vaccination dose.I have been vaccinated, but don't have my proof of vaccination.I have not had the COVID vaccine.
Professional Profile
Your Current Employer*
Put None if not affiliated.
What is your title or position?*
Please check all that apply below. We know this question is personal and sensitive, but presenting or performing at TBTN Events can be traumatic and triggering for some.*

Survivor of dating abuse/intimate partner violenceSurvivor of college rape/sexual assaultSurvivor of high school rape/sexual assaultSurvivor of adult rape/sexual assaultSurvivor of childhood abuseExpert/highly knowledgeable on sexual violence or sexual misconduct of any kindActivistVoice actorStage/theater actorFilm/screen actorPoetArtistDancerMusicianSinger/vocalistTikToker or YouTuberSocial media influencerAuthor/writerProfessor/teacherCounselor/psychologistCoachAthletePublic speaker
Provide your biography of 300 words or less highlighting your most relevant accomplishments and positions to-date.*
What training and/or study have you completed in the area of sexual violence, sexual harassment, and/or sexual misconduct? Please list when and where you received this training. If you have no training, please confirm you are willing to learn about these topics with the training materials we provide.*
List 3 recent (within the last 2 years) presentations or live audience performances you have given on any topic or that would demonstrate your abilities. Include the date, location, audience, and any link to social media or other press coverage. If you don't have any to list, please explain why you think you would make a great presenter or performer for TBTNF.*
What is your desired fee for a 30-60 minute program in person? Please note that most TBTN presenters and performers donate their talent to our cause. *
If you are willing to donate your program, please note this.
What is your desired fee for a 30-60 minute program online? Please note that most TBTN presenters and performers donate their talent to our cause. *
If you are willing to donate your program, please note this.
Upload your resume.*

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Upload a professional headshot photo.*

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Provide a link to a demo video of your presentation or performance, not longer than 3 minutes. *
Have you ever been convicted of any crime, including speeding violations?*

Yes, only speeding violationsYes, something elseNo
Please explain any criminal convictions, including when, where and what the crime(s) was. Put NA if None. *
Have you had a background check within the last year? If so, upload a copy here.

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Because we work with many different types of schools, they have a variety of rules with which our presenters and performers must comply. Please select ALL the items below with which you CAN comply while on campus or interacting with a client or their parents, students, faculty, coaches, and/or any other school employee or representative.*

Refrain from consuming alcohol.Refrain from smoking, using any tobacco product, and/or juuling.Refrain from flirtatious behavior or being alone in any space with a minor (including off campus).Refrain from swearing, cursing, or using other offensive language.
Travel
Do you have a car and car insurance?*

YesNo
Do you have a valid driver's license?*

YesNo
Are you comfortable flying on an airplane?*

YesNo
Are you comfortable being transported by your host to and/or from the Event?*

YesNo
Are you comfortable staying with a host family to perform at a TBTN Event?*

YesNo
Are you comfortable staying in a guest house or guest room to perform at a TBTN Event?*

YesNo
Do you have any special needs for travel?*

No
Is there anything else you think we should know related to your ability to travel and present at Events? Consider allergies, phobias, etc.
Social Media
Enter your LinkedIn Account, if you have one:
Enter your Facebook Account, if you have one:
Enter your Twitter Account, if you have one:
Enter your Instagram Account, if you have one:
Do you want to be a TBTN Fan and receive the TBTN Newsletter (free)?*

YesNo
Follow us!
Agreement
Agreement: The information I am submitting in this form is truthful and comprehensive. I understand my submission will be reviewed by TBTNF representatives and used by TBTNF to evaluate my application. I understand my submission is not confidential, and I understand TBTNF may use my submission, or any part of it, for any and all purposes of its choosing. ORGANIZATION and any affiliate or designee of its sole choice shall be entitled to unlimited use of any part of my submission.*

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