FCWWC Breakout Session Speaker Application

Thank you for your interest in serving as a breakout speaker for the First Coast Worksite Wellness Council!

This application is designed to gather information about your expertise and potential presentation topics. Please complete the Breakout Speaker Application in its entirety. Submitting an application does not guarantee selection as a breakout speaker. The First Coast Worksite Wellness Council Board will collectively review all applications and select speakers through a voting process.

Selected speakers will be notified in advance to allow ample time for presentation preparation.

We appreciate your time and consideration. If you have any questions, please contact info@firstcoastwwc.org.

1. Presenter Name *

2. Relevant Certifications/Credentials (e.g., "Wellness Certifications," "Health Coach Certifications")

3. Email Address *

4. Phone Number *

5. Preferred contact method (select all that apply)

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6. Company/Organization Name *

7. Address

8. Please select the option that best describes your experience presenting on wellness-related topics (e.g., nutrition, fitness, mindfulness, stress management, etc.): *

Beginner: Limited experience presenting on wellness topics.

Intermediate: Some wellness initiatives established & looking to grow.

Advanced: Proficient in engaging audiences on complex wellness issues.

9. Presentation Title *

10. Please provide a brief description of your breakout session to be included in marketing materials. *

11. Please list 3 learning objectives for your presentation. *

12. How will your presentation accomplish the learning objectives and provide attendees with greater knowledge of worksite wellness?

13. Please provide proof of performance if available (ie: letters of recommendation, live speaking videos, previous evaluations, etc.)

14. Please upload a biography and/or CV for all presenters *

15. Linkedin profile link

16. Facebook page link

17. Instagram profile link

18. YouTube Channel

19. Please attach presenter headshot to be used in marketing materials. *

I attest that the information provided in this application is true and accurate to the best of my knowledge and belief. I understand and agree to comply with all conference guidelines and policies. I also understand that FCWWC reserves the right to select and schedule breakout sessions based on their relevance and alignment with the conference objectives. *

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