Please fill out the information below to register to become a Brave Talks host.
Have you attended a Brave Talks session before?
*
Yes
No
Do you want to be involved in a Brave Talks session?
*
Yes
No
First Name
*
Last Name
*
Email Address
*
Date of Birth
*
Race
*
Ethnicity
*
Zip code
*
Are you willing to participate virtually?
*
Yes
No
Are you willing to meet in-person?
*
Yes
No
After 5 p.m., which days are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Please note that we will contact you if you are not available during the above mentioned times.
Do you need more options if you are not available during these times?
Yes
No
As the host, you are responsible for inviting seven to nine individuals to a Brave Talks session. Please add those individuals' names and email below.
1. Name of invited participant
Email Address
2. Name of invited participant
Email Address
3. Name of invited participant
Email Address
4. Name of invited participant
Email Address
5. Name of invited participant
Email Address
6. Name of invited participant
Email Address
7. Name of invited participant
Email Address
8. Name of invited participant
Single Line Text 8
9. Name of invited participant
Single Line Text 9
Please note that you will be contacted within two weeks.
