IIA BOOKING APPLICATION

1
WE THINK YOU ARE GENUINE * This field is required.
2
WHAT IS YOUR E-MAIL ADDRESS?* This field is required.
example@example.com
3
WHAT IS YOUR NAME?* This field is required.
Mr.
Mr.
Mrs.
Dr.
Ms.
Prefix
First Name
Last Name
4
WHAT IS YOUR PHONE NUMBER?* This field is required.
Country Code
Area Code
Phone Number
5
WHAT IS THE NAME OF YOUR ORGANIZATION?* This field is required.
6
DO YOU HAVE A WEBSITE?
7
WHERE ARE YOU LOCATED (CITY AND COUNTRY)?* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
ARE YOU PLANNING AN UPCOMING EVENT?* This field is required.
YESNO
9
HOW CAN ALEXANDER BLASS BE OF SERVICE TO YOU?* This field is required.
KEYNOTE SPEAKING ENGAGEMENT
MASTERCLASS TRAINING WORKSHOP
OTHER
10
WHAT IS THE NAME OF THE EVENT, IF ANY?
11
WHAT IS THE POSSIBLE DATE OF THE EVENT?
12
IS THE EVENT DATE FIXED OR FLEXIBLE?
FIXED - EVENT DATE CONFIRMED
FLEXIBLE - EVENT DATE NOT CONFIRMED
13
WOULD YOU PREFER IIA TO DO PRESENTATION IN-PERSON, OR VIRTUALLY/REMOTELY?* This field is required.
IN-PERSON
REMOTE/VIRTUAL
14
WHERE WILL THE IN-PERSON EVENT TAKE PLACE?* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
15
APPROXIMATELY HOW MANY ATTENDEES ARE YOU EXPECTING FOR IIA’S PRESENTATION OR GUEST APPEARANCE?* This field is required.
IN-PERSON NUMBER
VIRTUAL/REMOTE NUMBER
TOTAL NUMBER
16
WHAT IS YOUR MAXIMUM BUDGET (IN $USD) FOR IIA’S SPEAKING ENGAGEMENT OR GUEST APPEARANCE, *INCLUDING* ALL TRAVEL EXPENSES?* This field is required.
17
PLEASE LEAVE ALL ADDITIONAL INFORMATION HERE THAT YOU WOULD LIKE IIA TO KNOW ABOUT YOUR EVENT.* This field is required.
18
THANK YOU VERY MUCH FOR PROVIDING THIS INFORMATION. WOULD YOU LIKE TO SCHEDULE A FREE 15-MINUTE DISCOVERY CALL WITH A MEMBER OF OUR TEAM?* This field is required.
YESNO
19
CHOOSE APPOINTMENT TIME* This field is required.
20
THANK YOU FOR SCHEDULING YOUR CALL. A MEMBER OF OUR TEAM WILL CALL YOU ON THE PHONE. WHAT IS THE BEST PHONE NUMBER FOR US TO CALL YOU ON AT YOUR APPOINTMENT TIME?* This field is required.
Country Code
Area Code
Phone Number
21
IN ORDER TO SEND YOUR INFORMATION TO OUR TEAM, YOU *MUST* PRESS THE “SUBMIT” BUTTON BELOW.

IMPORTANT: YOU WILL SEE A "THANK YOU" PAGE IF SUBMITTED PROPERLY.
22
WHAT IS THE NAME OF THE EVENT, IF ANY?
23
WHAT IS THE POSSIBLE DATE OF THE EVENT?
24
IS THE EVENT DATE FIXED OR FLEXIBLE?
FIXED - EVENT DATE CONFIRMED
FLEXIBLE - EVENT DATE NOT CONFIRMED
25
WOULD YOU PREFER IIA TO PRESENT HIS MASTERCLASS IN-PERSON OR REMOTELY/VIRTUALLY?* This field is required.
IN-PERSON
REMOTE/VIRTUAL
26
WHERE WILL THE IN-PERSON EVENT TAKE PLACE?* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
27
HOW MANY FULL DAYS (APPROXIMATELY 8 HOURS EACH) WOULD YOU LIKE THE MASTERCLASS TO BE IN TOTAL?* This field is required.
1
2
3
4
5
28
APPROXIMATELY HOW MANY ATTENDEES ARE YOU EXPECTING FOR IIA’S MASTERCLASS?* This field is required.
IN-PERSON NUMBER
VIRTUAL/REMOTE NUMBER
TOTAL NUMBER
29
WHAT IS YOUR MAXIMUM TUITION BUDGETED *PER PERSON* IN USD THAT YOU ARE PREPARED TO INVEST IN THIS MASTERCLASS? YOUR ANSWER WILL HELP US RECOMMEND THE MOST SUITABLE PROGRAM FOR YOU.* This field is required.
MAXIMUM TUITION PER PERSON (IN $USD):
30
PLEASE LEAVE ALL ADDITIONAL INFORMATION HERE THAT YOU WOULD LIKE IIA TO KNOW ABOUT YOUR EVENT.* This field is required.
31
THANK YOU VERY MUCH FOR PROVIDING THIS INFORMATION. WOULD YOU LIKE TO SCHEDULE A FREE 15-MINUTE DISCOVERY CALL WITH A MEMBER OF OUR TEAM?* This field is required.
YESNO
32
CHOOSE APPOINTMENT TIME* This field is required.
33
THANK YOU FOR SCHEDULING YOUR CALL. A MEMBER OF OUR TEAM WILL CALL YOU ON THE PHONE. WHAT IS THE BEST PHONE NUMBER FOR US TO CALL YOU ON AT YOUR APPOINTMENT TIME?* This field is required.
Country Code
Area Code
Phone Number
34
IN ORDER TO SEND YOUR INFORMATION TO OUR TEAM, YOU *MUST* PRESS THE “SUBMIT” BUTTON BELOW.

IMPORTANT: YOU WILL SEE A "THANK YOU" PAGE IF SUBMITTED PROPERLY.
35
PLEASE LEAVE A DETAILED MESSAGE AND WE WILL FOLLOW UP WITH YOU SHORTLY.* This field is required.
Huge
Large
Normal
Small
Ok
Ok
36
IN ORDER TO SEND YOUR INFORMATION TO OUR TEAM, YOU *MUST* PRESS THE “SUBMIT” BUTTON BELOW.

IMPORTANT: YOU WILL SEE A "THANK YOU" PAGE IF SUBMITTED PROPERLY.
Should be Empty: