Expert Speaker Application

Thank you for your interest in the Expert Speaker Series at Isis Parenting. Please fill out this form as completely as possible. We will contact you if we are interested in adding you to the series. Be aware that we get many requests from potential speakers and have only a few spots to fill each month. Even if we do not contact you right away, your information will be kept on file and it is possible we will contact you in the future.

Be sure to review our Expert Speaker FAQ, which provides more specific details about how speakers are chosen, and how the events are scheduled and publicized. Click here to view this PDF document: http://www.isismaternity.com/expertspeakerform.pdf

1. Contact information:

Speaker Name

Position Title

Company Name

Street Address

City

State

Postal Code

Email Address

Preferred Phone Number

Website address (if applicable)

2. Prior public speaking experience (professional organizations, workshops, conferences):

3. Topic Category:

4. Title of Proposed Session:

5. Session Description:

6. Equipment Needs:

	Display screen--TV or LCD projector for PowerPoint (must provide own laptop)
	Easel
	White board/markers
	Electrical outlet/extension cord
	Other

7. Preferred Center(s):

	Isis Arlington
	Isis Boston
	Isis Brookline
	Isis Needham

8. General availability:

	Weekday evenings
	Weekends

9. Any other information you'd like to share with us:

	Parenting Skills
	Fitness
	Financial Information
	Childcare
	House & Home
	Medical
	Other