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Toastmasters District 67 Speakers Bureau Application Form |
| Application no. | |||
| English name | Chinese name | ||
| Phone Mobile: /Office: ext. /Fax: | |||
| Address | |||
| Name and Number of Club: | |||
| Membership Number: | |||
| The Date the ATM-B/AC-B and/or District Contest Champion granted: D/M/Y | |||
Personal Information |
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Present
Position
(please
include title, organization and main responsibilities): |
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Toastmasters Experience
(including
any leadership position ever in charged) |
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Education
Background: |
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Professional Experience
(related
awards, publications, lectures, etc.): |
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Reference
(comments
from the audience, personal website, etc. ) |
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Public Speaking Categories |
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| Area(s) of expertise as a public speaker | |||
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□ Keynote Address |
□ Humorous Speech |
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□ Sales Training Speech |
□ Seminar |
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□ Ceremony Host |
□ Workshop |
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□ Public Relations Speech |
□ Speech about Communication |
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| □ Speech about Leadership | □ Motivational Speech | ||
| □ Other Training Speech, please specify the area: | |||
| □ Technical Speech, please specify the subject: | |||
| □ Others, please specify: | |||
| Nature and Size of groups that will be benefited from your presentation: | |||
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□ Below 20 persons |
□ 20~50 people group |
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□ 50~100 people group |
□ 100~500 people group |
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□ 500~2000 people group |
□ More than 2000 people |
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□ Non-profit organization |
□ Hospital, Governmental Bureau |
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| □ Religious group | □ Corporation | ||
| □ Others, please specify: | |||
| Cities / Regions you're available for speaking engagements | |||
| □ Taiwan whole Area | □ North Taiwan ( Div A, C, E, G, H) | ||
| □ Central Taiwan ( Div B) | □ South Taiwan ( Div D) | ||
| □ East Taiwan | □ Taipei City | ||
| □ Taipei City & County | □ Tao Yuan & Taipei County | ||
| □ Tao Yuan County | □ Hsin-Chu County | ||
| □ Hsin Chu & Tao Yuan County | □ Miao Li & Taichung County | ||
| □ Taichung County | □ Chang Hua & Nan Tou County | ||
| □ Chang Hua & Yun Lin County | □ Yun Lin & Jia Yi County | ||
| □ Jia Yi & Tainan County | □ Tainan County | ||
| □ Tainan & Kaohsiung County | □ Kaohsiung County | ||
| □ Kaohsiung City | □ Ping Dong County | ||
| □ Kaohsiung & Ping Dong County | □ Peng Hu County | ||
| Signature | Date(D/M/Y): | ||
| Important: | |||
| Please return this completed form and other documents, with a photo in electronic file to vera@futis.com.tw Information from your application will be used only in the promotion of Toastmasters Organization by District Speakers Bureau. | |||
