Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Country Code
-
Area Code
Phone Number
Your Website
Skype
What topic/s do you currently speak on or do you want to speak on?
How many stages have you spoken on in the past 12 months?
How many stage would you like to speak on in the next 12 months?
When it comes to speaking professionally, what is the #1 single biggest challenge that you are facing right now?
What stage are you at in your speaking career?
Just getting started or speaking for free
Getting up to $500 per speech
$500-$1,500 per speech
$1,500-$5,000 per speech
$5,000-$10,000 per speech
$10,000-$25,000 per speech
More than $25,000 per speech
How much are you currently investing each month in your speaking business?
$0-$2,500
$2,500-$5,000
$5,000-$10,000
More than $10,000 per month
Which areas are you currently investing in to build your speaking career?
Speaking Coach
Business Coach
Online Courses
Mastermind
Seminars and Workshops
Books and Audio Programs
Speaker Association Membership
What do you expect your gross revenue to be in 2017? (CONFIDENTIAL)
What is your projected gross revenues for 2018? (CONFIDENTIAL)
Do you have the time, motivation and financial resources to attend this speakers retreat and grow your speaker business?
*
Yes, I'm ready
No, no at the moment
I'm not sure
Is there anything else you'd like to tell us about yourself to help us assess your application?
SUBMIT
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