diff --git a/pinaxcon/templates/symposion/proposals/proposal_leave.html b/pinaxcon/templates/symposion/proposals/proposal_leave.html
new file mode 100644
index 0000000000000000000000000000000000000000..dbaad0426dd9e94ad36da2b7079cfb1d36cd2747
--- /dev/null
+++ b/pinaxcon/templates/symposion/proposals/proposal_leave.html
@@ -0,0 +1,11 @@
+{% extends "symposion/proposals/base.html" %}
+
+{% block body %}
+    <h3>Leaving {{ proposal.title }}</h3>
+
+    <form method="POST" action="" enctype="multipart/form-data">
+        {% csrf_token %}
+        <p>Are you sure you wish to leave as a speaker on <b>{{ proposal.title }}</b>?</p>
+        <input type="submit" class="btn btn-primary" value="I am sure" />
+    </form>
+{% endblock %}