Test

First Name

Last Name

Do you have any co-moderators?

How will you promote your room?

What support(s) do you need from the TLB club?

LinkedIn Profile:

Instagram Handle:

Twitter Handle

Short bio, for moderator's introduction:

Who referred you to TLB?

Clubhouse Username

Proposed Room Name/Topic

Format: Panel, Fireside Chat, Open Discussion

Preferred dates and times for your room (in EST)

Phone Number

Email address: