DEI Speaker Submission Form
The State Bar of Texas is using this DEI Speaker Submission Form to collect information regarding Diversity, Equity and Inclusion (DEI) speakers.  The State Bar of Texas intends to share this information so that members of the State Bar of Texas can facilitate further education on this topic.  
Acknowledgements:
By submitting this form you agree that you have provided this information to the State Bar of Texas to share publicly, in its discretion. You understand that your email address and all other information provided on this form may be made publicly available and you consent to the public disclosure of all information provided. The purpose of providing this information is to provide diversity, equity and inclusion training resources and materials.

You acknowledge that the State Bar of Texas is not endorsing you or your material. Submissions may be excluded if they are inefficient or incomplete.

You further acknowledge that you have answered this questionnaire truthfully and accurately.

I have read and reviewed the above Acknowledgements: *
Name *
Email *
State *
City *
Phone number *
Website
Presentation Modality?  Select all that apply. *
Required
Degrees and Relevant Education: *
List any DEI certifications: *
Do you speak or provide training for free in some instances? *
Speaker Fee: *
If you have a speaker fee, what is your current rate?
Do you charge travel fee(s): *
Have your trainings been accredited for CLE in Texas? *
If you answered yes to the question above, what is the CLE number?
Areas of Expertise: (Select all that apply) *
Required
Audiences you have trained: (Select all that apply) *
Required
List of DEI speaking engagements in the last 6 months: *
Total Number of DEI trainings/presentations: *
Link(s) to previous presentations (if available):
List of at least 3 Professional References (include email addresses): *
Other DEI speakers or trainers you would recommend (include office phone number and link to website, if any):
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