| Name: Date: |
| Phone: Email: |
| Best method of contact: Phone Email |
| Age: Major/minor: Year in school: |
How do you identify?
|
Sexual Orientation
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Gender Identity
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| Please choose one: |
Please choose one: |
| If other, please specify: |
If other, please specify: |
Please describe your past public speaking experiences:
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Why are you interested in joining the speakers bureau?
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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
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Do you have any special needs when doing an engagement? Yes No If so, what?
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What kinds of groups would you especially like to speak to?
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What kinds of groups would you not want to address?
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Please add anything else about yourself that might uniquely qualify you for a certain speaking situation.
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| Please select the timings you are not available during the week.
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