Name *

First Name

Last Name

Phone

(###)

###

####

How did you hear about us?

Friends/Family

Colleague

Social Media

Website

Other

Workshop/Keynote participant

How do you think these challenges are affecting your career progression or leadership potential?

Holding me back from promotions

Holding me back from getting more clients/business

Reducing my confidence in high-stakes meetings

Limiting my ability to lead effectively

Hindering my relationships with colleagues/clients

Affecting how others perceive my leadership presence

Other (please specify below):

What is currently holding you back from making the impact you want in your role?

Lack of confidence

Cultural barriers

Lack of visibility

Communication skills

Other (please specify below)

If you could successfully improve your communication skills in the next 6-12 months, what would the ideal outcome be?

Check all that apply

Securing a big promotion

Securing more speaking opportunities (keynotes, panels, etc)

Delivering more impactful and memorable presentations or pitches

Building stronger relationships with colleagues and clients

Generally improving my confidence in public speaking

Communicating with confidence and ease with people at work or in networking situations

Other