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Speakers Bureau Listing Form

By completing this online form you agree to the membership terms. Click here to read them (PDF).

Please take some time to answer each question completely and accurately as we will be using this content for your official listing on the site. (Your phone numbers and email address  will not be listed on the web site.)  To make changes to your individual listing after it is submitted, contact the Bureau President.

We suggest the following before you begin completing the online form:

  • Click here to review a sample bureau listing or see the listing for other speakers.
  • Print this form to familiarize yourself with the information needed. 
  • Type the information for your bio and the speeches in a Word document, spell check it, and cut and paste to the online form.

All fields marked with * are required.
Contact Information
Email address: *
Re-enter the email address below
Select a password:*
Re-enter the password below
First name:*
Last name:*
Your mailing address:
Day phone number:*
Night phone number:
Cell number:
Fax number:
Your web site's URL: http://


Your Experience in Toastmasters * 
About your home Toastmasters club 
Highest level achieved in Toastmasters:
E.g., ATMS, ACG, DTM


Speaking Availability * 
Number of miles you're willing to travel to speak:
Which town would you be traveling from?
State:
How many days in advance do you require bookings?
Are you available for last minute fill-ins? Yes
What other presentation opportunities are you interested in pursuing? (Check all that apply)
Serving as master of ceremonies
Parade announcer
Career day speaker at a school
Keynote speaker for an event
Open to other opportunities
Preferred speaking days: (Check all that apply)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Preferred speaking times: (Check all that apply)
Mornings
Afternoons
Evenings


Speaker's Bio * 
(Please limit to 150 words) 


Speech Topics *
Topic categories for speeches: Separate categories with comma. 
For category ideas click here (PDF).


Speech #1 Information * 
Speech title:
Usual length: minutes
Can length be changed?
Description (less than 250 characters):


Speech #2 Information
Speech title:
Usual length: minutes
Can length be changed?
Description (less than 250 characters):


Speech #3 Information
Speech title:
Usual length: minutes
Can length be changed?
Description (less than 250 characters):


Speech #4 Information
Speech title:
Usual length: minutes
Can length be changed?
Description (less than 250 characters):


Speech #5 Information
Speech title:
Usual length: minutes
Can length be changed?
Description (less than 250 characters):


Submission
Submission code:*

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