Central Valley Dots Speaker Application

First Name *

Last Name *

Email *

Phone *

Where is your home Polka Dot Chapter? *

Are You Available to Speak Online or In-Person? *

Online (Virtual Meetings are 3rd Fridays at 10am PT)

In-Person (In-person Meetings are 2nd Fridays at 11:30am PT in Fresno)

Topic / Catchy Title of Your Talk *

Brief Description of your Talk *

3 Things that Attendees can Expect to Learn *

Short Bio for Introduction and to put on the PDP Website *

Ice Breaker Question (asked during introduction time in meeting) *

Link to Your Website *

Social Media Links (for connection and tagging) *

I would like to schedule an pre-interview Facebook live *

Yes

No

I agree to share on social media and invite friends to view my talk. *

I Agree

I acknowledge that my talk is not to include a sales or product pitch. I agree to my interview to be used on Social Media and will share the post at least one time prior to the meeting. *

I Agree

Upload Your Headshot and Any Other Graphics *

Upload Your Images

Thank you for applying to speak for the Central Valley Polka Dot Chapter in California.