Webinar Entry Form

Webinar Speaker Submission
Purpose: Presenting actionable, interesting help for people dealing with mental health issues. Free for attendees series.
Name*
First NameLast Name
E-mail*
Phone Number*
Area CodePhone Number
Your Website
Assistant's Name
Assistant's Email
Facebook URL
LinkedIn URL
Instagram Handle
Twitter Handle
YouTube Channel URL
Proposed Webinar Title
Proposed Content / Summary of Webinar
Is this webinar :
More a presentation with Q&AAn interactive workshop with audience interactions throughoutA fun and interactive eventAn educational classOther
Preferred Date/Agreed-on Date
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Date
How will you promote the event?
Are you offering a free gift or a product?*
Free Gift/ServiceProductJust sharing website or email as contact info
For those offering ONLY a free gift or free service...
Title of Gift/Service (please keep this to a 6-word maximum if possible)
Value of Free Gift/Service
Description of Free Gift/Service
For those offering ONLY a product...
Title of Product
Value of Product
Sale Price of Product
200 x 200 px product image for Main Gift (png format)
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Please upload your headshot photo and bio. Also include the primary contact information you want us to share with our audience
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Upload any other image/s or presentation .pdf you want to share
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Webinar Speaker Submission