Speaker Registration Form
Name_________________________ Do you speak a foreign language? ? Yes ? No What is your honorarium range? $_____ to $____ If you have never received an honorarium we will determine your workshop value. What types of workshops/training y would you like to be listed under? Check all that apply and add more under other if applicable. Training Keynotes Human Resources International Issues Motivational Diversity Empowerment Team Building Culture Other_____________ Other_____________ Signing this agreement allows Diversity Speakers to post your photo and bio on www.diversityspeakers.com and to send a marketing packet to those companies that call to inquire about you as a public speaker. Your name may appear on printed material, website, and promotional announcements. Information provided will be use to develop your personal speaker portfolio to present to clients. I solemnly swear that all of the information provided here is the truth to the best of my ability. I understand that if it is ever known that information provided here about myself is false I will be removed as a speaker from Diversity Speakers. Sign _____________________________ Date ____________________________
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