Empowered to tell our own stories Speaker Information Form * indicates required fields First Name* Last Name* Email Address*(will not be visible on the website) Area(s) of Interest / Expertise*Select as many as you wish (at least one). Supported decision-making and alternatives to conservatorships Education and inclusion Communication access Healthcare Racial and ethnic disparities Transportation and accessibility Autism Awareness and Acceptance Month History of the disability rights movement Other (specify:) Other Availability*Select all that apply (at least one) Virtual Presentation In-person Presentation In-Person Availability Location*Select all that apply (at least one) Northern CA Central CA Southern CA National/U.S. International Personal Statement* Please write your statement in third person perspective. Your statement should include your passions/interests, your personal connection to the subjects, your experience with public speaking, and any other relevant information to help organizations understand your expertise. (100 word max)Example statement: Sam is a dynamic public speaker with 5 years of presentation experience. Sam is most passionate about bringing awareness to issues around accessibility in education, motivated by his own experiences as an individual with a disability navigating the public education system. In addition to being a graduate of the DVU SASB program, Sam has presented at DVU’s Communication Access Connect, been a panelist at two Disability Rights conferences, and published a critically acclaimed memoir documenting his experience with disability.*Fee* When setting your fee, please keep in mind that fees should coincide with your experience level and should be a flat number (50, 100, 200, etc.) per hour or per speaking engagement. Remember to mention that travel and accommodations are additional fees if you are providing in person presentations. You can also put “Contact for pricing” if you do not want to list your fees and prefer to negotiate them with each organization independently. $* Upload a Photo*JPG or PNG only. Max file size 4MB.NOTE: For best results, we strongly recommend photos that are square.Accepted file types: jpg, jpeg, png, gif. Photo Preview: