This page is for District 30 Toastmasters to apply to the Speakers Bureau

Instructions 1. Read Speakers Bureau FAQ. 2. Complete the form below.  When you are finished, hit the "Submit" button. 3. Items in RED are required. 4. There are spaces on the form below to provide for up to four of your presentations to the Speakers Bureau.  If you have more than four presentations to submit to the Speakers Bureau, do the following.  Fill out the entire form to include your first four presentations and hit "Submit."  Then after that, complete all required (RED) information for each set of the next four presentations you are submitting.  For "Brief Bio" field of subsequent submissions, enter "see previous." 5.  Separately, send your photo (jpg or gif file) to:  6.  Hint: You may wish to print this page now.  Compose and edit narrative fields (e.g., "Brief Bio," the "Précis" for each presentation) beforehand.  When you're ready to complete the form, you can cut and paste each entry separately from your favorite word processor into the entry fields provided here.

 

Enter Your Contact, Club and Biographical Information (Items in RED are required.)
First Name
Middle Initial/Name
Last Name
CTM/ATM/DTM	CTMATM-BATM-SATM-GDTMna
CL or AL	CLALna
E-mail Address
2nd E-mail Address
Home Club Name
Home Club #
Home Address 1
Home Address 2
City
State
Zip Code
* You must provide either a evening or day time phone number.  Providing BOTH is best. * Other numbers are optional.  If you have access to those devices, contacting you might be easier. * Please include the AREA CODE for EACH phone listing. * When PHONE EXTENSIONS APPLY, after the number use "ext." followed by the phone extension number.
Phone - Evening (Include AC)
Phone - Day (Include AC)
Fax - Evening  (Include AC)
Fax - Day   (Include AC)
Cell Phone   (Include AC)
Pager   (Include AC)
Personal or Professional Web Page
Preferred Speaking Times	Days Evenings Weekends
How Much Advance Notice Do You Need Before a Speaking Engagement?
Any Special Requirements?
Brief Bio
Enter information for each presentation which you want listed for you in the District's Speaker Bureau.
Title of First Presentation
Usual Length (minutes)
Length Can Be Extended To:  (minutes)
Précis
Speech Category	Business Etiquette Career Transition Change Management Communication Educational/Informational Humorous/Entertaining Inspirational Leadership Life Balance Motivation/Achievement Personal Development Public Speaking Team Building Stress Management
Title of Second Presentation
Usual Length  (minutes)
Length Can Be Extended To:  (minutes)
Précis
Speech Category	Business Etiquette Career Transition Change Management Communication Educational/Informational Humorous/Entertaining Inspirational Leadership Life Balance Motivation/Achievement Personal Development Public Speaking Team Building Stress Management
Title of Third Presentation
Usual Length  (minutes)
Length Can Be Extended To:  (minutes)
Précis
Speech Category	Business Etiquette Career Transition Change Management Communication Educational/Informational Humorous/Entertaining Inspirational Leadership Life Balance Motivation/Achievement Personal Development Public Speaking Team Building Stress Management
Title of Fourth Presentation
Usual Length  (minutes)
Length Can Be Extended To:  (minutes)
Précis
Speech Category	Business Etiquette Career Transition Change Management Communication Educational/Informational Humorous/Entertaining Inspirational Leadership Life Balance Motivation/Achievement Personal Development Public Speaking Team Building Stress Management
	8-15-2005