Name
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First Name
Last Name
Email Address
*
Name as you'd like it to appear in marketing:
*
Name as you'd like us to refer to you (if different)
Gender pronoun(s):
*
Phone Number
Address
Title: (your job / business title - i.e. Queer Fat Activist, Founder of ____, ____ Coach, Writer, ____ Expert, etc.)
Organization(s) (if relevant):
Name & contact information of assistant (if relevant)
The topic or title for your interview (if you know/ have an idea)
Do you have any writing / videos / audio / FB statuses that you love / are relevant to the themes of the series that you'd like Elizabeth to review in advance of your interview?
Feel free to copy & paste links here or send them to Elizabeth directly. She may not be able to get to all of them, and she can at least link them on your speaker page.
What are your 3 favorite things to go really deep on?
A short bio (ideally around 100 words -- make it short & sweet!):
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Facebook page (optional):
Instagram (optional):
Share a different platform (optional):
Do you have any upcoming events or products or launches you’d like us to include on our resources page? Please give us all the relevant information (dates, URL, name, short description)
What are your most engaged platforms for reaching your audience? *
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What is the approximate size of these audiences?
What is the size of your email list(s) (if applicable and different from the last questions)?
What do you want to commit to in terms of promoting your appearance at this event?(Please reach out to your most engaged platform & select at least 2 from the list below.)
*
If you answered other in the item above, please describe below:
What dates are you promoting? (preference for concentration on launch date, at least once during promotion period and during series itself)
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Do you have any ideas for potential organizations or people whose audience might benefit from the summit? These could be folks you have connections with or not.
Title / name of your FREE gift offer (12 words max)
FREE gift description (30 words max) plus any unique directions for accessing the gift
EXACT URL where visitors can claim your free gift
