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.

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. 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.

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)

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.

Credit Card*

American Express

MasterCard

Visa

Card Number Expiration Date Security Code 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.

Email

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