Visible Impact Program Form 2023

VISIBLE IMPACT

Thank you for your interest in the VISIBLE IMPACT Program! Please complete the following registration form so that we can learn more about you, your needs, and your interest in the program.
Event Date

MonthDayYear
Date
Event
Name*

First NameLast Name
Email*
example@example.com
Opportunity Owner ID
Patricia Murillo ID
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title
Organization
Have you participated in How Women Lead activities/events in the past?

YesNo
What part of the organization are you most familiar or engaged with?

General leadership events and programmingWomen on BoardsHow Women GiveHow Women InvestWomen Leaders for the World/Global Advisor
Please share what is inspiring you to focus on elevating your brand at this time

Of the following topics that we’ll be covering, what is most important to you (please rank your top 3)

	Ranking
Your thought leadership journey
Personal branding roadmap
Your key strategic messages
Executive communication skills
Upleveling your LinkedIn Profile
Podcast development
Developing articles/blogs
Keynote presentation development

What are you most excited to get out of the Visible Impact Program?
LinkedIn address
Hold your spot
Cost for the program:
- ELEVATE YOUR VOICE: $ 3,500.- with an initial deposit of $ 1,000 to hold your spot.
- AMPLIFY YOUR MESSAGE: $ 3,500.- with an initial deposit of $ 1,000 to hold your spot.
- BOTH PROGRAMS: ELEVATE YOUR VOICE + GET OUT THERE: $ 6,000.- with an initial deposit of $ 1,000 to hold your spot.
Which option would you prefer?

ELEVATE YOUR VOICE ($ 3,500). Hold your spot for $1,000AMPLIFY YOUR MESSAGE ($ 3,500). Hold your spot for $ 1,000BOTH PROGRAMS ($ 6,000). Hold your spot for $ 1,000
What would you like to pay? (Elevate your voice or Amplify your message)

Full price ($ 3,500)Hold my spot ($ 1,000)
What would you like to pay? (Both programs)

Full price ($ 6,000)Hold my spot ($ 1,000)
Choose a payment type

Invoice mePaypal
Coupon Code
Paid now
Paying
Payment Amount

prevnext( X )
USDDescription
We will send you an invoice for the remaining balance with the cadence you selected:
Your Remaining balance
How would you like to pay the remaining balance of Both Programs?

One time payment3 installments (September, November, January)
How would you like to pay the remaining balance of Elevate your voice or Amplify your message?

One time payment2 installments (September, November)

Professional Background
Do you have board service experience?

YesNo
What type of board?

PublicNon-ProfitPrivatePrivate VentureVenture backedInternationalGovernmentSPAC
In what industry(ies) do you have primary professional experience in?

Adverting & MarketingAgingAgricultureAgritechAlternative EnergyArtificial IntelligenceAutomotiveB2BB2CBig DataBiotechBlockchainChild CareCivil RightsClean EnergyClimate change, Environmental justice, Conservation, WaterCognitive NeuroscienceCommercial BankingCommercial InsuranceCommercial LendingCommunity & Social ServicesComplianceConstruction / ArchitectureConsultingConsumer EnergyConsumer InternetConsumer ProductsCosmeticsCriminal LawCross-border, Government relationsCybersecurityDEIE-CommerceEconomic SecurityEducationEducation, LiteracyEfficiencyElderly CareElectric VehicleEnterprise AppsEnvironmental & SustainabilityESGFashTechFemTechFinancial PlanningFinancial ServicesFinTechFood & BeverageFood SecurityGames, GamingGender, SexualityGlobal LeadershipGreen BuildingGreen Consumer GoodsGreen FinancingGreenTechHealthcare, Public Health, Women's Health & Reproductive JusticeHuman ResourcesHuman rights, Social justiceInternet Of ThingsJournalismLanguage LearningLaw, Policy, Advocacy, Government, PoliticsLegalMachine LearningManufacturingMedicalMedical DeviceMicrofinanceMolecular BiologyNanotechnologyNatural BeautyNutritionPaymentsPetsPharmaceuticalsProduct DesignProduct PositioningPublishingRacial Equity, Diversity & InclusionReal EstateRenewable EnergyRetailRoboticsSalesScience, Biology & ChemistrySmart PowerSolar and Wind EnergyTechnologyTelecommunicationsTransportationViolence prevention/anti-human traffickingWomen and girls leadership & empowerment
Demographics

How Women Lead is committed to diversity, inclusion, and equity. We are asking the following demographic questions because we want to celebrate and connect people based on identities and develop programming that meets your needs. Please note these questions are optional.
Please share your age range

Below 3535 to 4545 to 5555 to 65Over 65
Do you identify as a Black, Indigenous, Person of Color (BIPOC)?

YesNo
What is your racial or ethnic identity? If you identify with more than one identity, please check the racial/ethnic identities that apply.

African American/BlackAmerican Indian/Alaskan NativeEast AsianLatinx/HispanicMiddle EasternPacific IslanderSouth AsianWhite/CaucasianOther/Prefer to self-describe
Do you identify as LGBTQIA+?
Should be Empty:

VISIBLE IMPACT

Hold your spot

Professional Background

Demographics