Speaking - Application Form

Personal Information

First name

Last name

Pronouns

Email

Phone

Organization/Business Name (if applicable)

Website/LinkedIn Profile

Background Information

Brief Bio (100-150 words)

Current Professional Role

Years of Experience in Perinatal/Infant Mental Health or Related Fields

Areas of Expertise

Session Proposal

Title of Proposed Session

Brief Description of the Session (150-200 words)

Key Objectives: What will participants learn or take away from your session?

Target Audience: (e.g., professionals, parents, caregivers, etc.)

Focus Areas

Intended Audience

Is your session intended for:

Providers (e.g., therapists, healthcare professionals, counselors)

Families (e.g., parents, caregivers)

Both

Format Preferences

Example of Your Work

Link

File upload

Desired Rate

Please indicate your desired speaking fee for this session. If you have flexible rates or different rates for various formats, please let us know.

Additional Fee Considerations (optional):

Additional Information

Is there anything else you would like us to know about you or your session proposal?

Future Opportunities

Would you be interested in participating in future training opportunities, conferences, or retreats hosted by us?

Yes

No

Maybe, please provide more information

Thank you for applying!

We’ll review your application and contact you regarding the next steps. If you have any questions, feel free to reach out to us at info@pearl-wellness.com.

Yes, subscribe me to your newsletter.

BLACK FRIDAY SALE - USE CODE BLACK25

Pearl Wellness Trainings