University of California Irvine
Lesbian, Gay, Bisexual, Transgender Resource Center

Speaker's Bureau Registration Form

 

Please complete the following Speakers Bureau participant registration form. Registration forms must be completed at least 1 day prior to the training date. You will receive email confirmation once we have added you to the list of participants for a particular training. An email will also be sent to you the week before or during the training as a reminder and with training logistics (such as location). For any questions about the training, please contact Matt Espino by email (mespino@uci.edu) or at the LGBT Resource Center (949-824-3277).

 

 

Name (First, Last):
Address:
City:
 State:
 Zipcode:
Home Phone:
Cell Phone:
Birthdate:
E-mail:
Student Status (undergrad, graduate, non-student, staff/faculty):
Your Major(s):
Minor: 
Projected graduation year:


Please answer the following questions: 

Briefly list prior experience; on the job (paid or volunteer), on a school campus, in-home or community experience:

 

What do you expect to gain from your speaker's bureau experience:

 


Please list one reference -- on campus or in the community. Include name, relationship and phone number: