SPEAKER APPLICATION FORM

Your Name *
Email Address *	Phone Number *
Organization Name
Street Address
City	Postal Code
Province
Phone Number	Fax Number
Website
Area of Expertise
Preferred Speaking Schedule
Preferred Geographical Area	Separate with comma for multiple areas
Have you had previous experience in public speaking? Yes No
If the answer is yes to above, how many times have you done public speaking in the past 2 years? < 5 times 5-12 times > 12-24 times > 24 times
Other Required Information (please submit as an attachment) Please upload the following documents in one zip file with filesize < 1 MB. Updated CV Headshot (colored photo in jpeg, gif, or compatible digital format, preferably small size) Past speaking experience (audience size and profile, program topic and setup, length of presentation) References (if any) Additional Remarks
CAPTCHA * Please enter the text shown in the image below (case insensitive) Submitting this form is only the first step in becoming SEI speaker. Once your completed application is received and reviewed, we will contact you to discuss your application and other relevant matters further. Fields marked with (*) are required to be filled

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