Speakers Bureau Questionnaire

Name*

Title First Last

Gender*

Male
Female

Email*

Personal website

Cellphone number*

Do you use WhatsApp?*

Position

If you hold more than one, please input the most significant one

Organization

Field/Profession*

(tick all that apply)

Where are you an educator?*

(tick all that apply)

Speaking Topics*

(tick all that apply)

Online live video shiurim

Are you available for video conferencing shiurim?*

Yes
No

If so, for which audiences?

Which other audiences?

How much would your honorarium be per video shiur? (in $US)

Comments about video conferencing shiurim:

Regular Honorarium

Amount in addition to payment of the plane ticket

(This will not be made public)

Weekend

Single lecture

Honorarium for Mizrachi events

Would you be willing to offer a 10% discount for Mizrachi booked events?*

Yes
No

Date availability

Please note: stating availability for a number of dates is not a commitment to travel for all of them

Are you available for the weekend of May 4, 2019 (the date chosen for the program in the US)?*

29 Nissan 5779

Yes
No

Are you available for the following dates (being considered for programs in other locations)

May 11, 2019*

6 Iyar 5779

Yes
No

May 18, 2019*

13 Iyar 5779

Yes
No

May 25, 2019*

20 Iyar 5779

Yes
No

June 1, 2019*

27 Iyar 5779

Yes
No

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Please attach a photo here:*

Hi-res if possible

Biography (200 word limit)*

Do you have any recommendations for speakers to join the Mizrachi Speakers Bureau?

Yes

Recommendations

Please fill in the name and email of up to 3 recommendations

Name 1

Email 1

Name 2

Email 2

Name 3

Email 3

Speakers Bureau Questionnaire

Online live video shiurim

Regular Honorarium

Honorarium for Mizrachi events

Date availability

Section Break

Recommendations

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