Speaker Basic Info Form – Workplace – Mar 2026

Check here after signing the speaker agreement.

The speaker agreement is what allows us to use this information and feature your presentation at the summit. You can click the link above or check the message in your inbox to sign the agreement before completing the rest of this form.

First Name

Middle Name/Initial (if you use one)

Last Name

Your Name Listed for the Summit

Write your name as you'd like it to appear in all summit materials

Pronouns (optional)

Square Headshot

Please upload a SQUARE headshot that's at least 600x600 pixels.

Your Title

Include your title as you'd like it to appear on summit promotional materials.

Website URL

Main social media link

If you have a different email address you want the audience to see, please share here

Email where you want to receive speaker updates

Short bio

Mailing Address (So I can send you a little gift :))

Address Line 1

Address Line 2

City

State

Zip Code

Country

Presentation Title

Enter the title you plan to use for your presentation. You're welcome to change this when you submit your presentation material, but this will give us something to put on the Registration and Schedule pages in the meantime.

Welcome Care Package

As you know, we will offer a free Welcome Care Package for all people who register for the Summit. We ask that all Speakers provide a practical tool that will provide an actionable step for participants to scaffold themselves and their environments after participating in the event.

It will be included on your presentation page and in a compiled package for attendees; this is a requirement for all speakers so that participants can be well supported in their first step of implementation.

-- This is the FREE package that all participants will receive --

If this is a tool that you currently charge for but are providing as a freebie as part of your presentation, please note the value of the tool. This can be a worksheet, an assessment, an affirmation card printable, a mini-course, a coloring sheet, or anything that you would like.

Do you currently have a tool available to add to the Welcome Care Package?

Yes, I know just the one

Yes, but not sure which one

Not yet, I'm working on it

No, I need help creating one

What is the name of the tool?

Please give a brief, but interesting description of the tool

What is the monetary value of the tool? (enter at least $9)

Are you ready to upload the tool or share the link?

Yes

No

If a mini-course, please insert the link here

If an online tool, please share clear access instructions for summit registrants

Welcome Package Files

Is there anyone else we should consider as a trauma-wise and lived experience speaker?

Optional Opportunities

Are you interested in sponsorship information?
Are you interested in information about sponsoring the event? This can include anything from a simple Bingo prize sponsor with a feature to all attendees to more premier sponsorship opportunities

Sponsorship Interest

Yes

No

The TraumaWise ToolKit Contribution

The TraumaWise ToolKit will be a value-packed addition to the presentations.

-- This is an OPTIONAL contribution to the paid package available for purchase to all registrants --

To make it even more valuable and to give you an additional way to collect attendee email addresses, we encourage you to provide a resource to add value to the TraumaWise ToolKit.

This includes things like:

Templates (most popular with attendees)
Trainings and workshops
Workbooks
Courses (big or small)
1-month memberships

(Note: We do not recommend any type of 1:1 contribution due to high-volume.)

While this isn’t required, it’s highly encouraged that you participate. It’s a great way to collect hundreds of additional email addresses (as attendees will provide their information to claim your bonus) and it makes it easier to promote since your audience will want what you’ve included.

We'll also bump your affiliate commission for the event to 50% as an extra thank you.

We’d love information about your bonus as soon as you’re able to provide it, but the final version is not due until about 4 weeks before the summit starts.

**Please note that attendees will be able to begin claiming resources as soon as promotion opens ~3 weeks before the Summit begins.

Will you be contributing to the TraumaWise ToolKit with a Premium Bonus?

Yes

No

I am not sure, yet

TraumaWise ToolKit Contribution Name

2-3 Sentence Description

Regular Price

This can be something you already have created. Examples include courses, workbooks, workshops, training videos, 1-month memberships, eBooks, etc. (This is not required, but very much encouraged as it will help you collect extra email addresses!)

Be clear about what they’ll get and how it will help them.

ToolKit Image Upload

Some type of image or mockup that will allow me to show off what you've contributed. If you don’t have one we’ll use a stock photo.

If you need to discuss any of your contributions, please feel free to set up a meeting with Renae!

Not mandatory, just an invitation.

Schedule a Zoom Chat with Renae

Basic Speaker Information Form

-- This is the FREE package that all participants will receive --

Optional Opportunities

The TraumaWise ToolKit Contribution

-- This is an OPTIONAL contribution to the paid package available for purchase to all registrants --

If you need to discuss any of your contributions, please feel free to set up a meeting with Renae!