Dear Green Industry Speaker:

Thank you for your interest in representation by Green Industry Speakers Bureau. Please carefully read and fill out the following application as comprehensively as possible and submit the form. We look forward to working with you!

The Green Industry Speakers Bureau Team

 

Your Contact Information: 

First Name :

 

 

Last Name :

 

 

Company :

 

 

Title :

 

 

Address :

 

 

City :

State :

Zip : 

Phone :

FAX :

E-mail:

 

 

Web URL :

 


Fill in as many as apply:

Speaking Topic 1, Title and Description
 

Speaking Topic 2 , Title and Description

Speaking Topic 3 , Title and Description

Speaking Topic 4 , Title and Description

 

Do you have Webinar presentations available? 

 Yes

No

(If you checked YES, please list title of all Webinar topics along with brief description and length of each presentation)


How many years have you received paid speaking engagements? 

 

What are your current fees for the following?

  • Keynote:

    • Local:  

    • National:  

    • International:  

  • Training/Workshop/Consulting:

    • Half-Day:  

    • Full-Day: 

If you have published any books, name the three most recent:
(Please email jpg of the covers of any books you have published)

Book Title 1
 

Book Title 2
 

Book Title 3
 

Do you have a video of a talk you gave to a live audience within the last 24 months?

 Yes

No

(If you checked YES and your video is available on Youtube, please copy and paste embedded code here)


Do you have a current U.S. passport?

Yes

No

 

From what major airport do you typically travel from?

Name of Airport  
City  State 

Please write a brief bio, include any testimonials you have received about yourself, as a professional speaker which will be included on the website:

 


Attach a current color headshot photo of yourself in jpg format
(which will be posted on the website on your profile page) and email photo to: info@greenindustryspeakers.com 

 
Once you have filled out this form, download the PDF Speakers Contract, 
sign and fax signature page to (805) 493-0269.