Summer Speaker Event Registration of Interest

Summer Speaker Event Registration of Interest

Are you ready to share your purpose & passion ? Complete this form to tell me why I should choose you!
Full Name*

First Name Last Name
E-mail the one you use please! *
Contact Number*

Area Code Phone Number
Your Address - where are you based on the planet?*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
This Event will take place in the UK -Date (June / July or Early August) - please confirm you will be able to attend in the flesh :-)*
Please let me know any dates you are not available in June/July/ Early August
Tell me about speaking ....why do you want to do this ....is it to increase your income? your presence? to make an impact?*
What would you like to speak about?*

My ProductMy ServiceMy Why (life purpose)
Where have you spoken in "public"*

Only with Friends & FamilyIn Front of a Live AudienceLive On LineOn Video
How many people have you spoken in front of?*

Never spoken in publicTo a small group of less than 10To a medium group of less than 100To a large group of 1000 or more
Tell me your story ... whats been stopping you from speaking? What is the current problem? What have you tried so far? Why is now the right time for action? Where would you like your life to go from here in terms of your personal &/or professional life?*
Due to the service we offer, we only have limited places - Why should we pick you? *
And on a scale of 1 (not a lot) & 10 (I'm ready to invest time, money & energy) How much do you want the opportunity to speak? *
Thank you for taking the time to complete this form :-)

Good Luck with your application.

If you do qualify, I will invite you to a live zoom call to discuss the event in more detail

Speak soon

Cheryl
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