Online Speakers Application

Speakers Application Form

Full Name *

Address (No. and Street Name) *

City *

Province / State *

Postal / Zip Code *

Country *

Phone *

Valid Email

Website

Are you a CSD Member? (yes/no) *

Presentation Title *

Describe in 75 words or less, what your presentation is about, how it relates to dowsing and how it will be of interest to dowsers. *

In 75 words or less give a biographical sketch of your relevant background and experience. *

Speaking Choice *

Will you require the use of an overhead projector? (yes/no) *

Will you require the use of a projection screen? (yes/no) *

Will you require hte use of a flip chart / markers? (yes/no) *

Will you require the use of a digital projector? (yes/no) *

Will you be giving a handout to the audience? (yes/no) *

Would you like a free table in ou Marketplace Area? (yes/no) *

Type the characters you see in the picture below

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