Speaker Info

Tell us about yourself

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Name and District Number of your Toastmaster Club(s)*

Occupation and Employer*

Accomplishments / Hobbies / Special Interests*

Speech/Program Info

You may enter information for up to three (3) speeches/topics

How many speech program topics would you like to submit (up to 3)?*

1
2
3

1. Speech Title*

1. Speech Subject*

1. Speech/Program Length*

1. Ideal Audience - Who needs to hear this speech?*

1. Brief (2-3 sentence) description of your topic.*

2. Speech Title

2. Speech Subject

2. Speech/Program Length

2. Ideal Audience - Who needs to hear this speech?

2. Brief (2-3 sentence) description of your topic.

3. Speech Title

3. Speech Subject

3. Speech/Program Length

3. Ideal Audience - Who needs to hear this speech?

3. Brief (2-3 sentence) description of your topic.

Delivery Methods

Tell us how you prefer to deliver your speech.

Methods of Presentation. Check all that apply.*

In-person
Hybrid
Virtual

Whcih is your first choice? Check one only.

In-person
Hybrid
Virtual

If hybrid or virtual, check all the platforms you are familiar/comfortable.

If "Other," please list:

Times you would be unavailable:*

How far are you willing to travel?*

Other comments, remarks, or things you'd like us to know.

Attachments

Please add your required supplemental items below to complete your application. You may attach files directly or provide a link to an outside source (i.e. Website, YouTube, Dropbox, etc.).

Attach 50 word max Bio (MS Word or PDF format.

Max. file size: 512 MB.

Link to Bio

Attach Professional Headshot (jpg, png, or PDF format) 512MB file size max.

Max. file size: 512 MB.

Link to Photo

Attach 3-5 Minute Video (MP4 or WAV format) 512MB file size max.

Max. file size: 512 MB.

Internet Video (e.g. YouTube)

Electronic Signature*

First Last

Request a Speaker

Toastmasters Appalachian Speakers Bureau Application Form

Speaker Info

Speech/Program Info

Delivery Methods

Attachments

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