SPEAKER APPLICATION

INTERNATIONAL ALCHEMY CONFERENCE 2012

SPEAKER APPLICATION

To be considered as a speaker at this year's Alchemy Conference,

fill in the form below and click "Submit." You can also attach files

(resumé, formal proposal, flyers, specification sheets, etc.) for our

consideration at the bottom of the form.

information: The conference will take place in October 2012.

Please note that presenter selections will be made by January

15th, 2012. Applications submitted after this date will be

handled as scheduling allows and may be postponed for

consideration until next year's conference.

First Name: *
Last Name: *
Title/Credentials:
E-mail Address: *
Website/Blog:
Home Phone: *
Other Phone:
Address: *
Apt/Suite/etc.
City: *
State/Province: *
Postal Code: *
Country: *

Full Bio (1,000 Words):
Enter your complete bio or attach your resume.
Short Bio (150 words): *
Enter a short bio to be used in our program and website.
Speaking Experience:
List other conferences or lectures you have given or attach in resume.
Type of Presentation:

*
List details and specifications of the type of presentation selected above, including time requirements, workshops fees, handouts, type of demonstrations, etc.
Presentation Title: *
Co-Presenter Name (if any):
Presentation Description: *
Describe your presentation and the topics you will be covering.
In what category does your presentation best fit? *
Modern Alchemy (New Applications) History of Alchemy & Alchemists Personal Transformation (Psychology) Quantum Alchemy (Science) Social Alchemy (Politics & Economics) Planetary Alchemy (Environment) Medical Alchemy (Healing Arts) Practical Alchemy & Spagyrics Spiritual Alchemy & Philosophy Hermetic Sciences (Kabbalah, Tarot, etc.) Astrology & Cosmology Art, Literature, & Film Performance Entertainment or Artwork Other (explain in box below)

List details and specifications of the type of presentation selected above, including time requirements, workshops fees, handouts, type of demonstrations, etc.
How does your presentation relate to the conference theme of alchemical transformation? *
How will your presentation explain or enhance the universal principles of alchemical transformation and positive change?
What will attendees gain from your presentation?
What tools or knowledge do you expect to convey to attendees?
What audio/video or special equipment is required for your presentation? *
Estimate wattage required for special equipment.
What audio/visual or special equipment will you be bringing with you?
List any projectors, amplifiers, labware, or other equipment that you plan to take to the conference.
Available Days (leave blank for any):
In what ways can you help us promote the conference?
Do you have mailing lists, a website, blog, radio/TV program, or other way in which to help promote the conference?
Additional Comments:
Enter any other comments or requirements you may have.
Attach Presentation Proposal and/or Resume:

Verification Code:
Enter Verification Code: *


* Required