/ Continuing Education/ TransActive Guest Speakers / Activity Leader Application

TransActive Guest Speakers / Activity Leader Application

All fields marked with asterisk (*) are required.

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Contact Information

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First Name*

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Last Name*

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Email Address*

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Street Address*

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City*

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State*

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Zip Code*

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The following information may be used for flyers/promotional materials, on our website, and on social media:

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Biography*

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Website

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Social Media Handles (Instagram, Twitter, Facebook)

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Title of Presentation / Activity*

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Description of Presentation / Activity*

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Length of Presentation / Activity*

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This presentation/activity is for youth ages... (check all that apply)

4-9

10-13

14-18

Parents

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Any co-presenters/co-activity leaders? (Name/Email/Phone Required)

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Availability (General Dates/Times that work for your schedule)

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TransActive is committed to host our Fall and Spring programming remotely. Do you have experience using the Zoom platform?

Yes, I have hosted an event on Zoom

Yes, I have participated in a Zoom event

No, I am not familiar with Zoom

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Photo

Please attach an optional photo for promotional materials

(50 MB max)

Link (required)