12Petals Fireside Chat(s) Registration
Welcome to the 12Petals Fireside Chat(s) Registration Form. Please indicate the Fireside Chat(s) that you will be interested to attend.

Information provided in this form will be used for our verification, admission and attendance-taking purposes when we administer the Fireside Chat(s) on Zoom.

You will receive the Zoom links from us at hello@weare12petals.com prior to each Fireside Chat, so be sure to check your emails (Inbox/Spam) for updates.

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Email *
Full Name *
Please make sure to change your Zoom display name to the name you are using to register for the Fireside Chat [FSC]. It will help us to verify and admit you into the Zoom session.
Area of residence *
City, State, Country
Age *
Profile of Participant *
Required
Which Fireside Chat(s) will you be attending? *
You may select more than 1 FSC.
Required
How did you find out about 12Petals? *
What questions would you like our speakers to address during the FSC?
Please state the title(s) of the FSC and corresponding questions. We will try our best to address these questions, subject to time constraints.
A copy of your responses will be emailed to the address you provided.
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