Speaker Form - C3EB Summit

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Speaker Form

Dr. Aparajita Jeedigunta, PhD

[email protected]
808.282.6329

Thank you for your interest in becoming a speaker for the C3EB Mini Summits. Please answer the following questions and use the Calendly link at the end of the form to schedule a chat with AJ so that we can move forward.
Name (for internal communication purposes)*
First Last
Best Email to Reach you for Internal Communication Purposes*
Your name as you would want it displayed on our website and banners:*
Your title as you would want it displayed:*
Your organization as you would want it displayed:*
Your email address as you would want it displayed:*
Your short bio (please limit it to 200 words):*
Please upload a hi-res headshot. Either .jpg or .png is acceptable.
Max. file size: 500 MB.
(Please make sure your file is labeled firstname lastname.jpg or firstname lastname.png)
A telephone number where we can best reach you (this is for internal purposes only):*
Facebook Profile name:
Facebook # of friends/followers:
Instagram Handle:
Instagram # of followers:
Twitter Handle:
Twitter # of followers:
LinkedIn Url:
LinkedIn # of connections:
Website URL:
Can we display your social media handles and website on your speaker page?*
- Yes
- No
How did you hear about us?
- A previous speaker told me about it
- I attended the previous C3EB Summit
- I was invited by AJ
- Saw a Facebook post
- Saw an Instagram post
- Saw a LinkedIn post
- Saw a Twitter post
- Other
The following Mini Summits have been scheduled. Please pick one summit:*
- November 19 – 20, 2020 12 pm – 8 pm
  Tracks focus: Corporate Leadership, Small Business and Entrepreneurship, Educational Equity, Data and Metrics
- February 18 – 19, 2021 12 pm – 8 pm
  Tracks focus: Economic & Financial Equity, Policy/Infrastructure Equity – social & corporate, Environmental Equity
- May 20 – 21, 2021 12 pm – 8 pm
  Tracks focus: Societal & Cultural Equity, Health and Wellness Equity
Sessions will run for 50 minutes total. 5 minutes for intro/closing, 30 minutes for your content and 15 minutes for audience q&a. Do you agree to keep your content to 30 minutes?*
- Yes
- No
Also, for the mini-summits we will not be running multiple sessions simultaneously. With this in mind, please pick up to 3 times when you will be available to talk in the mini-summit you chose in the previous question. We will do our best to accommodate you.
Day 1
- 12:30 – 1:20
- 1:30 – 2:20
- 2:30 – 3:20
- 3:30 – 4:20
- 4:30 – 5:20
- 5:30 – 6:20
- 6:30 – 7:20
Day 2
- 12:30 – 1:20
- 1:30 – 2:20
- 2:30 – 3:20
- 3:30 – 4:20
- 4:30 – 5:20
- 5:30 – 6:20
- 6:30 – 7:20
Tentative Title (we can finalize this closer to the date of your talk):*
Content – Please give me at least 3 talking points so we can make our promotional materials:*
What is the Diversity, Equity, Inclusion and Belongingness problem you will be highlighting?*
What is the BIG unique solution that you will be proposing for us to move forward?*
How is your content going to be different from the “usual” status quo talks we get on DEI&B?*
How will your talk help our audience think or act differently going forward?
As a part of being a C3EB Summit Speaker, you will be provided the social media images, graphics, and copy templates with registration links. In addition to resharing our posts, you will be required to put out at least 3 social media posts and send out at least 1 email to your email list to help us promote the Summit. Do you agree to do this?*
- Yes
- No
As a part of the C3EB Summit framework, we are now offering public speaking training and presentation tips webinars to ensure the standards and quality of our events. These will be of no charge to you. They are not mandatory, but we highly recommend them as you will be able to meet other speakers and learn some best practices that would help you while you also help us maintain our quality and value for our audience. Do you wish to participate in these sessions?
- Yes
- No
Please schedule your chat with Dr. AJ over here:

https://calendly.com/ajrao/virtual-coffee-with-aj

Thank you for your interest in contributing your time and expertise to the C3EB Summit! We look forward to talking to you.

Sincerely,
The C3EB Summit Team
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