Speakers Bureau Application Speakers Bureau Application Form Name Address Email Phone Occupation / Role Employer Please tell us if you sit on any boards and your role within that organization Dates and details of previous events and role i.e. Keynote speaker, Panelist, Moderator. Also you may include interviews that you have had for radio and news outlets etc. Your professional bio (max 500 words) Check list Completed application Headshot (to be emailed) 250 x 250 pixels How far are you prepared to travel to attend speaking engagements? Within an hour radius of my home town Ontario only Canada Wide Other - please state reCAPTCHA Submit
