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Contact Information

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Phone 4

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Current Occupation

1. My interest in the Speakers Academy program is:

 I want to apply

I am VERY enthused and would like to apply to the program. I understand that the program costs $1,995 for non-members and $1,395 for NSA/NC members. I have read and I understand the Speakers Academy Program information.
I agree that, once accepted, the program tuition is non-refundable.
 I'm considering it

I am enthused about the program, and I need to consider the following items before making my final decision:

2. What are your areas of speaking expertise?

3. Are you a member of NSA?

 I'm a current member of NSA
 I'm a salaried employee

How many times per year do you speak to groups of 15 or more?
 I'm not a salaried employee

How many times per year are you paid to speak?

4. Are you speaking professionally?

 Full-time — # years
 Part-time — # years
 Occasionally — # years
 Have never presented

5. What is your past speaking experience?

 Member of Toastmasters, Speaking Circles, etc.
 Attended other presentation skills programs:

 Spoken at Rotary, Lions, Soroptimist, other organizations (describe)

How many times in the last two years?

6. What types of speaking programs do you intend to present?

 I don't know yet

7. On which topics do you speak?

8. Please share details from any book(s) published

9. Which of the following do you have or produce? (check all applicable boxes)

 Articles published on a regular basis
 Demo video

10. I can commit to the following, barring unforeseen events:

 Attend all eleven monthly meetings of Speakers Academy
 Do all homework assignments
 Attend all five NSA/NC general membership meetings
 Apply for membership of NSA when I meet the qualifications

11. Do you have any disability needs requiring special consideration?

12. Is there anything else you would like to share about yourself?

Please double-check all of your information above. Once you submit your application successfully, this form will be cleared. You will be emailed a copy of the accepted information.

Please contact Marit Fox at (650) 646-4220 or for more information.

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