Toastmasters District 54 Fall 2014 Conference
Workshop Speaker Submission

“The Amazing Race”

Friday November 7 & Saturday November 8, 2014

Holiday Inn Hotel & Suites - Bolingbrook, IL 60440

Deadline for submission: September 1, 2014

Form Rev 7/13/2014

Page 1 of 2

Name:______

Address:______

City:______State/Province: ______ZIP/Postal Code: ______

Phone No.:______E-mail Address:______

Web site:______YouTube channel / Video link:______

Have you ever been a Toastmaster? Yes[ ] No[ ] (“No” does not exclude you from consideration)

If yes, what isthe name and location of your club?______

Sessions will be presented on Saturday (November 8), and should be 40 minutes including Q&A.

What is the title of your proposed presentation? ______

Please provide an overview of your proposed presentation:______

What are the key concepts attendees will take away from your presentation?

  • ______
  • ______
  • ______
  • ______

Please continue with the questions on page 2

Describe your experience with this subject and how you developed your expertise:

If this topic doesn’t meet our needs, and you are willing to speak on a different one,
please provide additional topics for consideration:

_

Please provide a brief bio (150 words):______

_

What types and sizes of audiences have you spoken to previously? (Please list by date, group name and size):

_

Please provide two professional references who have heard you speak on this topic or others. Please include name, title, e-mail address and telephone number (Fall 2014 Conference Committee members are acceptable):

1) ______

2) ______

Do you have product to sell? Yes [ ] No [ ]

If so, please describe:______

Please submit this form to

(or contact us via the email above for questions, or details if you need to submit via postal mail or FAX)

Our Program Advisory Committee will review all proposals received by
September 1, 2014 and contact all candidates by September22, 2014.
We appreciate your interest in speaking at the Toastmasters International District 54 Fall 2014 Conference.

Visit our website atD54Conference.com