Application for Speakers Bureau

Here you will submit your information to be posted in the Speakers Bureau Directory. This will be reviewed by the Speakers Bureau Committee and then sent to the Web Team to upload to the Speakers Bureau page at www.district48.org. Your contact email is required for the Speakers Bureau to contact you. You may have a different email posted in the directory. The name and photo associated with your Google account will be recorded when you upload files and submit this form.

Name*
First Last
Email*
Phone
Club Membership
Email as you want it to appear in the Directory*
Your Toastmaster educational achievements
Your education achievements (AA, BA, MA, etc) if applicable to your topics
Who you are and what problem do you solve in 50 words or less.*
Title of 1-3 of your 30 minute presentations.*
Will you speak to Adult Assisted Living/Adult Communities?*
- Yes
- No
Subject areas that you speak about.*
- Humor
- Leadership
- Business
- Inspiration
- Storyteller
- Other
Upload your photo - 185x185 px, JPG, or PNG.*
Drop files here or

Accepted file types: jpg, png.
Email
This field is for validation purposes and should be left unchanged.