Your Full Name
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First Name
Last Name
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Your Web Address Here
Email
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example@example.com
Phone Number
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Area Code
Phone Number
Please submit a SHORT bio 100-150 words-Only 150 words will be published so please keep it short. If it is longer than 150 words my team will use it's own discretion, which you might not love, so please keep it short.
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The interview is free flowing so you don't need to prepare, but I will ask about your free gift and if there is anything special (ie. a book release, retreat or any event you'd like to promote) you'd like me to ask you on our interview?
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What is the title of your free gift? Please no 1:1 sessions. I am looking for a URL where you have an option for women to opt in and receive a gift (PDF, mini course, checklist, etc. anything that will help women succeed) and also grow your list.
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What is the link to your free gift?
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Please add a headshot image
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The promotional period is September 15-30. What date you will promote to your email list so we can keep track and offer support if needed.
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Month
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Day
Year
Date
YOU CAN ADD YOUR SPEAKER AGREEMENT RIGHT HERE AND HAVE THEM SIGN IT RIGHT HERE.
JUST CLICK FILE UPLOAD TO UPLOAD YOUR AGREEMENT.
Please sign the Speaker Release Here
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