Register Your Interest

If you would like to apply for membership, please complete the following form and we will be in touch soon.

Name
First Last
Gender
Email
Phone
Billing Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Why do you want to join?*
What are your speaker goals for the next 12 months?*
What are your Speaking Topics?*
Number of speaking engagements in the past 6 months?
What is your speaking experience over the past 12 months? Include in person events, conferences, webinars, podcasts, media interviews, speaker panels, keynotes, Zoom speaking engagements, online/in person summits etc
Please write a short bio (that we can use to introduce you if you become a member).
Were you recommended by someone or nominated by (existing PSANZ member), if so, whom?
Your Facebook
Your Twitter
Your LinkedIn
Your Google+
Your Website URL
Your Instagram
Do you have any questions for us?
Please provide the names and details of 2 x referees who have engaged you to speak to a minimum sized audience of 6-8 people, not necessarily for invoiced charges. Please note they will not be contacted without your permission. For more information around the requirements for Membership please check the membership page.
To apply please read and agree to our code of ethics*
I have read and agree to the PSANZ code of ethics PDF above
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