Unleash Your Story Speaker Program

Please fill out the form below so we can get to know about you, your story, and your desire to build your speaking skills.
Your Name

First NameLast Name
Your Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Phone Number
Format: (000) 000-0000.
Your E-mail
example@example.com
Are you willing to promote yourself as a speaker if you obtain the skillset and tools?
Select all that apply. I am interested in...
Select all that apply. I am also interested in these optional opportunities...
Did a friend refer you? If so, what is their name? If not, how did you find us?
For Option #1 of the speaker program that includes speaker coaching, the business of speaking, professional feedback on my speech and speech delivery, I understand that there is an investment for this program. Select all that apply:
For Option #2 of the speaker program that requires professional video production of your speech on stage, we rely on your personal funding or your fundraising to produce a professional video speaker reel for you. This includes investing in your own travel and accommodations to San Diego, CA. This speaker video reel is what you will use to launch or build your speaking career. Select all that apply:
In a few sentences, tell us about your inspiring story. What was your challenge? How did you overcome it? How did you grow from this experience to become who you are today?
Who is your target audience? Who do you want to speak to?
What are the 3 main inspirational messages you want your audience to know?
Are you a published author?
What is the name of your book or what is your book about?
On a scale of 1 to 10, rate your confidence speaking on stage
Do you have fears or doubts around sharing your story publicly?

Other
If you answered yes to the above question, why do you have fears or doubts? Are you willing to find the power in your story so you can share it from a state of empowerment rather than victimhood?
Would you like breakthrough around your story or around your fear of speaking so you can become a more impactful, confident, and powerful speaker?

Other
Have you spoke before on stage with an audience? If so, how many times and how big was the audience?
What would you like to get paid as a keynote speaker?
What is your vision for getting your story out into the world? How many people would you like to reach?
At Unleash Your Rising / Unleash Your Story a big part of our philosophy is giving back. How do you want to give back from your success and overflow? Who do you want to bless? What philanthropic mission will you create or what charitable organizations would you like to give back to? What is your give from your heart?
Why do you want to speak?
What are you most excited about if we are a mutual fit for this speaking program with me, Christine Gail, and our team?
Is there anything else you would like us to know?
Should be Empty:

Please fill out the form below so we can get to know about you, your story, and your desire to build your speaking skills.