Speaker Request Form

    About the Applicant

    Please answer these questions as yourself

    About the Speaker

    Please tell us about the speaker. If you do not know the answer to any of the questions, please take the time to reach out to the Speaker and find the correct answers before submitting.

    Is the Speaker's employer a current member of the Greater Kitchener Waterloo Chamber of Commerce?
    YesNoUnsure

    Please select the Speaker's preferred gender pronouns (PGP):
    He/Him/HisShe/Her/HersThey/Them/TheirsZe/Hir/HirsJust My Name Please (No Pronouns)Prefer Not to Disclose

    Does the Speaker Identify with an underrepresented community?
    The GKWCC is an advocate for equity and is committed to ensuring representation in its community. We welcome applicants from visible minorities, women, Indigenous peoples, persons with disabilities, persons of minority sexual orientation and gender identities.
    YesNoPrefer Not to Say

    About the Presentation

    Tell us about the Speaker's unique topic, story, or area of expertise. We do not accept any sales pitches and prefer to feature original content created for our membership.

    Using no more than 10 words, please provide a draft title for the proposed presentation. (Note: GKWCC reserves the right to edit final titles).

    Going into greater detail, tell us more about the content the Speaker would cover during their presentation.

    What makes the Speaker an expert on this topic?

    Please select the Speaker's preferred format(s) of presentation (check all that apply).
    Keynote presentation (engaging presentation on one idea)Panel Discussion (facilitated discussion, contributing to a conversation with multiple panelists)Fireside Chat (A conversation between you and a moderator)Workshop (interactive presentation & discussion)Moderator (you facilitate a conversation between multiple speakers. You provide occasional comments/context, but leave most content to the speakers)

    Please indicate the length of time the Speaker feels confident speaking for (check all that apply).
    Less than 10 minutes10-20 minutes20-30 minutes30-45 minutes45-60 minutes

    If given the choice, which event (or event series) would the Speaker prefer to speak at? Please check all that apply. You can refer to our website for additional details on each event/event series.

    Chamber Academy Series (approx. 50 attendees, workshop/lecture style)Chamber Young Professionals (approx. 80 attendees)Networking Breakfast Series (approx. 120 attendees) (topics range drastically and could include: government relations, leadership, healthcare, technology, education, talent, tourism, etc.)Energy & Environment Forum (approx. 150 attendees)Point of View Luncheons (approx. 150 attendees) (topics range drastically and could include: government relations, leadership, healthcare, technology, education, talent, tourism, etc.)Leadercast (approx. 200 attendees)Manufacturing Summit (approx. 350 attendees)Women's Leadership Series (including: Luncheons, International Women's Day, Inspiring Women Event) (approx. 150 attendees for luncheons, 350 attendees for International Women's Day, 750 attendees for Inspiring Women Event

    Speaker's Experience and Background

    Please attach the Speaker's Biography (PDF)

    Please provide any links to examples of previous speaking engagements.

    If you have anyone we can contact for a testimonial, please provide their name(s) and contact information (up to 3)


    Additional Assets

    Please attach the Speaker's headshot (JPG or PNG)

    Please attach the Speaker's Press Kit if they have one (PDF)

    Other

    Does the Speaker give consent to the Greater Kitchener Waterloo Chamber of Commerce to capture photo, audio and/or video recording(s) of their presentation, and share them online (via website, youtube and social platforms) following the event?
    YesNoUnsure

    Will the Speaker waive any applicable speaking fee(s)? (Please be aware that the GKWCC does not have the budget to pay speakers for our events)
    YesNo

    Do you have any additional information/comments you would like to provide?

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