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Engagement Requests

We’re excited to learn more about how we can partner to support your inclusive workplace and leadership journey.

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Date form submitted*

Requesting Company / Organization*

Organization Type*

Company/Organization Website*

Company Address*

Street Address City State ZIP Code

Contact Name*

Contact Title*

Email address*

Phone #*

Engagement Type*

If Speaking, name and description of event

Keynote

Fireside Chat

Panel Moderator

Panelist

Approximate number of attendees

Are you interested in a pre or post appearance

(Q&A, Reception, Meet & Greet, etc.)

If yes, please describe.

Are there other potential or confirmed speakers for this event?

Please list other potential or confirmed speakers for this event

Media - will there be media present?

If Yes, which media outlets?

Is there a charge for attending this event (Ticket price)

Ticket Price

If custom Consulting / Advisory, please describe current situation/challenges, desired outcomes and audience #/description.

Please share an overview of the Learning & Development (training) experience (including audience # and desired outcomes).

If Other, please provide a brief description of the request, including desired outcomes, and audience.

Delivery Format*

In-Person

Virtual

Pre-Recorded

Licensing Content

Please provide the City, State, and Country.

Timeline or Date of Appearance?*

Provide the specific date you are requesting or a date range for when you want to start and end the project.

Are you interested in information on the options to purchase copies of the Waymakers book for the participants/attendees of this event?*

Project Approval & Budget*

This project is ...

Approved Budget $

If not approved, when do you anticipate making a final decision?

Any additional details or comments that will help us best support this request?

How did you hear about us?*

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Engagement Requests

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