Professional Speakers Guild Membership Application

To join the Professional Speakers Guild, please completely fill out the below form and click the submit button. Your new member investment for a one-year membership in the Professional Speakers Guild is US$100 beginning from the month of your application. This includes your own web page (See this example) in the PSG on-line directory with a free e-mail and web site link, participation in our Members Only forums where you can talk to other experienced professional speakers to get tips, tricks, and much more. You can also submit articles for publication on the Professional Speakers Guild website.

If you wish to have a photograph of yourself on your page, please e-mail us an electronic photo or send us an electronic photo on disk. If you do not have an image in electronic format you may send us a photograph which we will scan and convert. However, there is an additional $10 charge for that service. After you fill in the below form, the next page will give you the addresses for emailing or USPS mailing your photograph.

Name of Applicant
First Middle Last

Letter designations to follow your name if any: i.e. CPA, DTM etc. separate with commas

Descriptions of Designations (Complete wording, appropriate short form, and granting organization, i.e.: Certified Public Accountant, CPA, American Institute of CPAs)

Company Name (if any)
Business Address
Street City State                              ZIP
 
Country
Business Phone
Business Fax
Mailing Address (If different from above)
Street City State                              ZIP
 
Country
Home Phone (for our records)
Create Your Web Page

Please input below the information you wish us to use in creating a web page for you in the PSG on-line directory. This will be a fixed layout such as in this example.

Please note the information you are about to enter will be electronically translated to create your web page. Great care should be taken to ensure that it is free of errors and omissions. If you have a photograph online you wish us to use, please provide a full link to it in the field below.
 
E-Mail address
Web Address (If any) http:// 
Weblocation of your photograph
(eg. www.mysite.com/mypic.jpg) 		http:// 
Your biography (1024 characters maximum)

Program Titles
(Max 55 characters per title)







Mission Statement (500 characters maximum)

Available Materials e.g., books, tapes etc.: (max 500 characters)

Consulting Services: (max 500 characters)

Keywords that will help customers find you (keywords or phrases, 11 words total and none repeated, separated by commas). Please include the full spelling of your state, e.g. Florida not FL.

I was referred by
Individual Name or Organization
City or E-Mail Address
You may now send this information to a review page. We encourage you to check it carefully. The review page is a secure form and, after checking your data, you will be asked to choose a payment method. A secure form has 128 bit SSL encryption! Personal and credit card information submitted from this page is encrypted to prevent third-party interception.
 
Note: For administrative purposes all credit cards will be processed through the courtesy of Mastering Technology, Inc. and will appear that way on your credit statement.

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