Information for You Awakening Guest Appearance Speaker's Name* Mr.Mrs.MissMs.Dr.Prof.Rev.Master Prefix First Last Email* Phone*Date of Appearance* Date Format: MM slash DD slash YYYY Time (EST) of Appearance* : HH MM AM PM Key Staff MembersKey Staff Contacts (Name, Role, Email & Phone)Publicity InformationSpeaker’s Topic Title:Provide appealing title options. Subject line size. The "What's in it for Me?" for Potential ListenersProvide a Short Description of What Benefits a Listener can Expect (include bullet points)Headshot Photo of SpeakerPlease submit your photo here. If you have previously submitted your photo and do not require updating, leave empty. Drop files here or Accepted file types: jpg, png, gif, pdf. Brief Speaker Bio (Please Add Your Bio Here)(Leave blank if previously submitted)Special OfferLink to Special Offer Autoresponder Info for Post PurchasePlease provide whatever is needed to fulfill the purchase. Examples are: how to schedule a session, how to attend teleseminars and get replays, digital links, and Facebook group links.Regular retail price for your offer*Special telesummit price for your offer*Bonus InformationList of bonus(es) with full description and picture (if available) and their “retail” value to be place on the bonus page as a Thank You for signing up for the event.Bonus DetailsIf you are providing one or more bonuses, please list with full description(s), plus the image(s) if available. Also, include the retail price if purchased through your site.Bonus picture(s)Accepted file types: jpg, png, gif, pdf.Additional comments...Mailing To Your List and Social Media ContactsDate of First Mailing (swipe copy provided to promote series) Date Format: MM slash DD slash YYYY Date of Second Mailing (you create for your event directing to www.youawakening.com to register) Date Format: MM slash DD slash YYYY Payment InformationPayPal AddressPlease provide PayPal address for payment after the season's encore recordings have been aired.Mailing Address as Back Up Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
