Cart
0
About
Meetings
Contact
Become a Member
Cart
0
About
Meetings
Contact
Become a Member
Speaker Registration
Speaker Name
*
First Name
Last Name
When have you been asked to speak?
(Leave blank if you haven't already been approached by a Rotarian for a specific date)
MM
DD
YYYY
Speaker Phone Number
*
(###)
###
####
Speaker Email Address
*
Speaker Topic
*
Please include a few sentences explaining the topic you will be addressing, include any appropriate links that we can send to members before/after the meeting.
Speaker Bio
*
Please include a few sentences on your background and qualifications.
Will you need media access?
*
Check 'yes' if you plan to share a Powerpoint, photos, video, etc.
Yes
No
Additional Notes or Questions
Who referred you to this form or asked you to speak?
First Name
Last Name
Thank you!
