Request To Speak Form - The Global Workplace Wellness Community (GWWC) of Practice

Name*
First Last
Email*
Company*
Please attach a 500 characters bio.: Give a brief description of your background, expertise, or a best practice you will be sharing.:
Please provide a description of your session in 500 characters below

Please provide 3-5 bullet points about your topic::*
Please share how your topic aligns with the theme of creating a Wellness Competency Mindset
Please outline the learning objectives of your topic::
Please share three take aways from your session
Please share your topic Title and key Phrase
Have you presented on this topic in the past?
Please list where have you presented on the topic and what was the response?

On which platform are you most active?
Total size of your following (mailing list and social media)*
On which platform do you have the most influence?*
- Select All
- E-mail List
- Facebook Group
- Instagram
- Twitter
- YouTube
- Pintrest
- Blog/Website
- Other
Where do most of your followers interact with you and share consume your content?
Please add your social media platforms, Facebook, LinkedIn Instagram or Website links
Would you be willing to promote the upcoming summit to your network? If so, tell us how.

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Are you willing to attend and share the current summit?
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