Name*

First Last

Email*

Address*

Street Address City State ZIP Code

Mobile Phone*

What is your area of speaking expertise?*

Are you currently a member of NSA or NSA St. Louis?*

No, I am not a member of NSA national or NSA St. Louis
No, but I am a past member of NSA St. Louis, NSA national, or both
No, I am a salaried employee who speaks as part of my work
Yes, I am a current NSA national and/or NSA St Louis Member

What is your past speaking experience?*

Please check all that apply.

Member of Toastmasters
Attended other presentation skills programs
Spoken at Rotary, Lions or other similar organizations
Speak/conduct training, etc. as part of a salaried position
None

How many times have you spoken to a group for 40 minutes or more in the past two years?*

What types of programs do you intend to present?*

Please check all that apply.

Keynotes
Seminars
Training
I don't know
Other

I commit to ALL of the following, barring any unforeseen events:*

Select All
Attend all sessions of the NSA STL Speakers Academy
Do all homework assignments
Attend all three of the monthly meetings of NSA STL while enrolled in Speakers Academy
Apply for national membership in the NSA and in NSA STL when I meet the qualifications

Do you have any disability needs requiring special consideration?*

**If Yes, please describe

Will you be attending in-person or virtually?*

In Person
Virtually
I will need to attend using a combination of in-person and virtual

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

Did someone refer you to Speakers Academy? If so, who?*

Speakers Academy sessions will be recorded. Your in-person or virtual attendance at these meetings serves as your permission to be seen in the recordings, which may be used for marketing or educational purposes. Please click the button below to indicate that you understand recordings you appear in may be used for these purposes.*

Yes, I understand and give my permission

Speakers Academy Fall 2022