Stalking Stories of Maryland

Speaker/Contributor Application Form 2026

We are compiling an internal list of potential speakers, legislative bill supporters, and more. Once you complete this form you will be contacted when applicable opportunities arise.

This form will primarily be for speaking engagements but it may also be used to recruit interviewees, research participants, and more. Information gathered will help us coordinate with you, but we will potentially contact you for other opportunities too.

Anyone can contribute, we encourage providers who support victims, family and friends who have been affected by stalking, and others who may have a story to share to sign up. Please complete all applicable sections. All answers are confidential.

If you have questions, concerns, or want to change your responses, please contact us directly at info@juststalkingmdresources.org.

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1. Name

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2. Preferred pronouns

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3. Do you identify as a:

Stalking Victim

Friend or Family of Victim

Provider for Victim(s)

Other (please specify)

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4. Languages (other than English).

Second Language

Third Language

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5. Email

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6. Phone

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7. How do you prefer to be contacted?

Call

Text

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8. Are you under 18 years old?

Yes

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9. Emergency Contact AND/or Guardian

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10. Phone of Emergency Contact AND/or Guardian

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11. Do you live or work in Maryland:

Yes

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12. Were any of your experiences in Maryland (or presently in MD):

Yes

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13. List the counties in each region that you are available to speak in:

Western, Maryland

Greater Baltimore, MD

Capital Metro, MD

Eastern Shore, MD

Southern, Maryland

Virtually Only

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14. Do you have the following:

Reliable transportation

A valid driver's license

Proof of insurance

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15. When are you available to speak? (Select all that apply.)

	Early morning (8-10am)	Late morning (10-12pm)	Early afternoon (12-2pm)	Late afternoon (2-4pm)	Early evening (4-6pm)	Late evening (6-9pm)
Monday	Monday Early morning (8-10am)	Monday Late morning (10-12pm)	Monday Early afternoon (12-2pm)	Monday Late afternoon (2-4pm)	Monday Early evening (4-6pm)	Monday Late evening (6-9pm)
Tuesday	Tuesday Early morning (8-10am)	Tuesday Late morning (10-12pm)	Tuesday Early afternoon (12-2pm)	Tuesday Late afternoon (2-4pm)	Tuesday Early evening (4-6pm)	Tuesday Late evening (6-9pm)
Wednesday	Wednesday Early morning (8-10am)	Wednesday Late morning (10-12pm)	Wednesday Early afternoon (12-2pm)	Wednesday Late afternoon (2-4pm)	Wednesday Early evening (4-6pm)	Wednesday Late evening (6-9pm)
Thursday	Thursday Early morning (8-10am)	Thursday Late morning (10-12pm)	Thursday Early afternoon (12-2pm)	Thursday Late afternoon (2-4pm)	Thursday Early evening (4-6pm)	Thursday Late evening (6-9pm)
Friday	Friday Early morning (8-10am)	Friday Late morning (10-12pm)	Friday Early afternoon (12-2pm)	Friday Late afternoon (2-4pm)	Friday Early evening (4-6pm)	Friday Late evening (6-9pm)
Saturday	Saturday Early morning (8-10am)	Saturday Late morning (10-12pm)	Saturday Early afternoon (12-2pm)	Saturday Late afternoon (2-4pm)	Saturday Early evening (4-6pm)	Saturday Late evening (6-9pm)
Sunday	Sunday Early morning (8-10am)	Sunday Late morning (10-12pm)	Sunday Early afternoon (12-2pm)	Sunday Late afternoon (2-4pm)	Sunday Early evening (4-6pm)	Sunday Late evening (6-9pm)

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16. How many hours can you commit to a (speaking) engagement?

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17. Have you spoken (shared) publicly about your experience before?

Yes

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18. Please select which of the following you are willing to participate in:

Interviews (E.g. Newspapers or Documentaries)

Legislative testimony (Oral or Written)

YouTube and Podcasts

Research

Trainings (E.g. Forums, Work-groups)

Other (please specify)

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19. Do you have any materials to share when you present? (Eg: presentation, books, short film etc.)? If yes, please describe.

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20. Participants must consent to be on our email list to participate. Please select which emails you would like to receive.

Only emails for this group "Stalking Stories of Maryland" (speaking engagements)

All Volunteer & Internship opportunities

All Upcoming Events & Announcements

Newsletters

All Emails

Stalking Stories of Maryland

Speaker/Contributor Application Form 2026

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* 1. Name

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* 2. Preferred pronouns

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* 3. Do you identify as a:

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* 4. Languages (other than English).

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* 5. Email

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* 6. Phone

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* 7. How do you prefer to be contacted?

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* 8. Are you under 18 years old?

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* 9. Emergency Contact AND/or Guardian

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* 10. Phone of Emergency Contact AND/or Guardian

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* 11. Do you live or work in Maryland:

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* 12. Were any of your experiences in Maryland (or presently in MD):

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* 13. List the counties in each region that you are available to speak in:

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* 14. Do you have the following:

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* 15. When are you available to speak? (Select all that apply.)

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* 16. How many hours can you commit to a (speaking) engagement?

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* 17. Have you spoken (shared) publicly about your experience before?

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* 18. Please select which of the following you are willing to participate in:

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* 19. Do you have any materials to share when you present? (Eg: presentation, books, short film etc.)? If yes, please describe.

Question Title

* 20. Participants must consent to be on our email list to participate. Please select which emails you would like to receive.

1. Name

2. Preferred pronouns

3. Do you identify as a:

4. Languages (other than English).

5. Email

6. Phone

7. How do you prefer to be contacted?

8. Are you under 18 years old?

9. Emergency Contact AND/or Guardian

10. Phone of Emergency Contact AND/or Guardian

11. Do you live or work in Maryland:

12. Were any of your experiences in Maryland (or presently in MD):

13. List the counties in each region that you are available to speak in:

14. Do you have the following:

15. When are you available to speak? (Select all that apply.)

16. How many hours can you commit to a (speaking) engagement?

17. Have you spoken (shared) publicly about your experience before?

18. Please select which of the following you are willing to participate in:

19. Do you have any materials to share when you present? (Eg: presentation, books, short film etc.)? If yes, please describe.

20. Participants must consent to be on our email list to participate. Please select which emails you would like to receive.