Stand Up Survivor Conference Speaker Interest Form

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We're so excited that you're interested in being a speaker at our conference on April 30, 2022! Please fill out the form so that we can learn more about you. We look forward to getting to know you.

What is today's date? *

YYYY

What is your name? (first & last) *

What's your email address? *

How did you hear about Stand Up Survivor?

Are you available to be in Orlando (in person) on April 30, 2022 *

Yes

I'm only available virtually

I understand that if chosen as a speaker I will not receive any financial compensation *

I understand

I understand that I may be requested to interview before final selections are made, and that I should monitor my email (inbox and junk folder) for an email from rachels@standupsurvivor.org *

I understand

I understand that, if chosen, I will need to submit my materials to the event organizers before the conference *

I understand

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