Heartwell Program Application

Your Information

* Indicates required field

Name *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Presenter Bio *

What do you teach? *

Website/Facebook/Linkedin *

Email *

PROGRAM APPLICATION

This information will be used to determine the eligibility of your program. Please be detailed and descriptive as possible. Please also check our calendar to ensure that your desired program date is available.

Program Title *

Program Type *

Anticipated Program Size *

Intended Target Audience *

Program Description *

Program Outline/Itinerary *

Month *

Day *

Year *

Time *

Is this a recurring program? If so, how many occurances? *

Cost/Fee to Participants *

Participation Requirements *

What can participants expect to learn/takeaway from your program? *

License/Certificate/Credentials *

Max file size: 20MB

MEDIA KIT

We'll need this information to publish your program should it be accepted. Although this is not mandatory to complete this application, submitting your media kit greatly increases the quality of your program, our ability to promote is, and the overall likely-hood of success. If a media kit is not yet available, you may send it to us later via email.

High-Res Headshot *

Max file size: 20MB

Flyer/Brochure *

Max file size: 20MB

Trademarks/Logos *

Max file size: 20MB

Program Cover Photo *

Max file size: 20MB

TERMS AND CONDITIONS

I Agree *

I understand my program is subject to approval.

Submit Program Application

HOST A PROGRAM
AT HEARTWELL

Your Information

PROGRAM APPLICATION

MEDIA KIT

TERMS AND CONDITIONS

About Heartwell

Join our mailing list

HOST A PROGRAM​AT HEARTWELL

Your Information

PROGRAM APPLICATION

MEDIA KIT

TERMS AND CONDITIONS

About Heartwell

Join our mailing list

HOST A PROGRAM
AT HEARTWELL