FSA Speakers Academy Registration 2021

FSA CONNI GORDON SPEAKER ACADEMY

APPLICATION
Your Name*

First NameLast Name
Your LinkedIn Profile Name
Company:
Company Website:
Title:
Email
example@example.com
Phone Number

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please check all that apply

I am a current paid NSA Essential MemberI am a 2nd Yr. FSA Aspiring SpeakerI have attended FSA Meetings in the past
Professional Designation(s):
What is your present job or business? Describe what you do and who you do it for?
What is your area of expertise? What topics do you speak on or wish to speak on?
What specific goals do you want to accomplish by participating in the FSA Conni Gordon Speaker Academy program? Why is this program right for you at this time?
Describe any volunteer activities for the FSA chapter or other NSA chapters?
Please list ten recent presentations (paid or unpaid)
How did you learn about the FSA Conni Gordon Speaker Academy?
In addtion, please email separately documentation for ONE of the following to our Speakers Academy Co-Chairs:

1. Toastmasters Competent Communicator Award or more advanced certification or Level 2 Pathways Certification

OR

2. Live Audience Video Provide an uncut 3-5 minute video of you speaking in front of a live audience. You Tube link is fine.

OR

3. Three Paid Speaking Engagements Provide date, description, and client contact information

SEND YOUR DOCUMENTATION TO :

Dave Bricker

Academy Chair

dave@davebricker.com
You may pay your Academy Tuition Via the FSA website. PAY HERE.

There are no refunds on the tuition except in the rare case that your application is not accepted for the program.
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FSA CONNI GORDON SPEAKER ACADEMY