Information Needed from Fireside Chat Advisors on Tap
  1. Contact/Coordinates
  2. Name(*)
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  3. Email(*)
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  4. Title/position(*)
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  5. Organization(*)
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  6. Address(*)
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  7. Telephone #(*)
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  8. Fireside Chat details: Required 2 months or more prior to the chat
  9. Title of Fireside Chat(*)
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  10. Date/Time confirmed with CHNET-Works! Animateur
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  11. Description of Fireside Chat (to use for website and email broadcast list postings)
  12. 4-12 sentences to include an enticing description, objectives of the chat, possible discussion items, and call to action as well as any web links to related resources you would like participants to review prior to the chat
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  13. Brief Bio
  14. (2 - 4 sentences)
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  15. A Digital Picture of yourself (optional) for posting on the website and presentation - Size limit 500 KB
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  16. Who are the key audience sectors for this 'chat'?
  17. Please identify any key organizations and/or communications venues that can be used to reach the audience via promotions. Any contact names and coordinates would be extremely helpful!
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  18. Other required items: PowerPoint Presentation (required 2 working days prior to the chat)
  19. Enter what you see:
    Enter what you see:
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  20.