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Straight Talk! Speakers Bureau
Speaker Electronic Application Form

Name:  Date:
Phone:  Email:
Best method of contact:  Phone Email
Age:   Major/minor:   Year in school:
How do you identify?
    Sexual Orientation
Gender Identity
    Please choose one: Please choose one:
    If other, please specify: If other, please specify:
Please describe your past public speaking experiences:
Why are you interested in joining the speakers bureau?
Please describe your knowledge of LGBT identity:
(For example, have you taken classes, read books, read information online, been active in an LGBT group, have LGBT family/friends, etc...)
Do you speak any languages besides English (including signing)?  Yes No
If so, which?
Would you be able to drive to speaking engagements if needed?  Yes No
Do you have any special needs when doing an engagement?  Yes No  If so, what?
What kinds of groups would you especially like to speak to?
What kinds of groups would you not want to address?
Please add anything else about yourself that might uniquely qualify you for a certain speaking situation.
Please select the timings you are not available during the week.
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PM