Upgrade to Professional Member - Professional Speaking Association

Your name*
Title First name Last name
Company / organisation name
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Telephone
Mobile Telephone*
Email*
Website*
Which Regions would you like to attend?*
Select at least one. However you can select as many as you like.
- East of England
- London
- Midlands
- East Midlands
- North East
- North West
- South East
- South West
- Staffordshire
- Thames Valley
- Yorkshire
- Scotland
- Ireland
Which Region are you most likely to attend?*
Why do you want to make this application?*
List your 10 most recent speaking events*
Please list your TEN most recent speaking events for audiences of 3 or more people. (Click the + sign to add a new row.)
Date Event Audience size
I earn money from speaking*
- Yes
- No
Link to video of you speaking
Please provide a link to a video of you speaking, either on YouTube or another online video service or your own website.
First proposer's name*
The name of your first proposer. You require TWO proposers who can be either Professional Members or Fellows but can not be current board members. Associate Members cannot propose you for this grade of membership.
First Last
Second proposer's name*
The name of your second proposer.
First Last
Date you were seen speaking by a proposer*
Please enter the date on which one of your proposers saw you speak. You must have been seen speaking within the last 12 months.
Date Format: DD slash MM slash YYYY
Proposers agreement*
- I confirm the proposers above have agreed to support my application
How did you hear about the PSA?*
Referrer's name
Have you been introduced to the Association by another member? If so please provide their name below so we can thank them. (One name only please).
First name Last name
Ethics*
- I confirm I agree with the ethical principles of the PSA
You are required to agree to the ethical code of conduct of the PSA. (Link opens in new tab)
Age confirmation*
- I confirm I am 18 years old or older
If you are under 18 and interested in membership, please contact us to discuss. (Link opens in new tab)
Annual Subscription - Professional Member
This is a recurring annual card payment for Professional Membership of the PSA. Your card will be charged £225 now and again on each anniversary of your membership.
Payment card*

Card Details

Cardholder Name
Important information about membership upgrades
Completing this form will result in your card being charged for the full £225 Professional Membership fee now. Your annual renewal date will also change to today's date.
We will review your membership status when processing your application. A pro-rata refund will be issued for any unused time on your previous membership grade if applicable.
- I do not wish to receive information from the PSA after my membership has come to an end.
When I submit this form, I understand that the PSA will process my information in accordance with its Privacy Notice.
Comments
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Date	Event	Audience size