Contact Information
Name
*
First Name
Last Name
Organisation/Company Name
Your Title
Email Address
*
Phone Number
*
Website (if applicable)
Event Details (where known)
Event Title
Event Date ( or month/year proposed)
Event Location (on/offline)
Event Description
Audience
Who will be attending the event? (Please provide a brief description of the audience, including their roles and backgrounds).
Speaking/Training Format.
Please choose one.
Preferred Format
Keynote Speech
Workshop/Training Session
Duration
Estimated Duration of the Speaking/Training Session.
Additional Information
What specific outcomes or results do you hope to achieve through this speaking/training engagement?
Are there any specific challenges or issues you would like Leigh to address during the session?
Is there any additional information you would like to provide that might be relevant?
Budget
Please indicate the budget available for the speaking/training engagement (if applicable).
Thank you for taking the time to complete this application form. Once submitted, we will review your information and our Client Experience Manager will then be in touch to arrange a discussion with Leigh.
LEIGH HOWES
Executive Coach & Consultant
(+44) 7968 512519
Let's Connect!
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