"Cool Women/Hot Jobs" Speaker Application

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* 1. Name

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* 2. Job Title

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* 3. Company

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* 4. Address

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* 5. Phone #

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* 6. Email

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* 7. Career Field (ex: medicine, law enforcement, education, etc.)

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* 8. High School Attended

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* 9. Undergraduate College Attended and Degrees Received

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* 10. Graduate College Attended and Degrees Received

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* 11. Please tell us a little bit about yourself.

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* 12. Please tell us about some of your typical job duties.

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* 13. Would you prefer to host a solo interactive workshop or be part of a speaker panel?

Solo Workshop

Speaker Panel

Either

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* 14. If you prefer to do a solo workshop, please describe the type of interactive activity you could facilitate.

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* 15. Please indicate which part(s) of the day you are available to attend.

Session 1 (9:35 - 10:15 am)

Session 2 (10:20 - 11:00 am)

Keynote Address (attendance only) (11:05 - 11:45 am)

Table Talk/Lunch (11:50am - 12:30 pm)

Other (please specify)

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* 16. Please submit any other questions or comments.

Thank you for your interest in participating in "Cool Women/Hot Jobs"! YWCP will collect all of the applications and create a speaker/workshop schedule, which will be emailed to participants by January 7th.

Feel free to call the YWCP Foundation Office at 585-254-0320 x1115 if you have any questions.