The Bureau Application Form

By completing this form I am requesting to be considered for The Bureau by LeadingRE. I understand The Bureau is a speakers and consultancy offering for LeadingRE members and is not an offering for outside the LeadingRE network.
1.My Name
Note: If there are certifications you wish to have listed on your profile, please note them in the field "Certifications". Any titles listed in the "Name" field will be removed.
2.Certifications
3.My Title
4.My Company
5.My Company Address
6.My Phone Number
7.My Email Address
8.Please select the description that most closely matches your request.
SPEAKER APPLICANTS ONLY RESPOND TO QUESTIONS 8-12. When questions 8-12 are complete, proceed to question 16 to complete the survey.
CONSULTANTS skip to question 13 and complete the remainder of the survey.
9.Speakers: I can provide videos of my past speaking engagements and/or feedback from prior speaking engagements.
10.Speakers: Please provide references contact information and/or video links in the space provided.
11.Speakers: My speaking services include:
12.Speakers: My Topics include
13.Speakers: My ideal audience is comprised of:
SPEAKERS ONLY: Please proceed to Question 16 and complete the remainder of the survey.
14.Consultants: I can provide examples of my past consulting engagements, professional experiences and areas of expertise.
15.Consultants: Please provide references/contact information for previous consulting engagements.
16.Consultants: Do you provide services such as temporary help? For example – if an office had a relocation director who left unexpectedly, would you be open to performing as an interim relocation manager?
17.Speakers and Consultants: What are your travel requirements? (please indicate reimbursement expectations, travel and hotel accommodation expectations)
18.For Speakers and Consultants: Please indicate your fees as a speaker and/or consultant.
19.For Speakers and Consultants: What is your availability?
20.For Speakers and Consultants: Please identify any restrictions such as time out of office limitations, not speaking to competitors, etc.
21.Speakers: My topics include (please list all that apply):
Thank you for completing The Bureau Application Form. You will be contacted to discuss and complete the application process.