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* Indicates required question
Email
*
Your email
About You
First Name
*
Your answer
Last Name
*
Your answer
Position
*
Your answer
Email
*
Your answer
Company Information
Company Name
*
Your answer
Company Phone #
*
Your answer
Company Website
*
Your answer
Organization Type
*
College or University
Non Profit (Religious)
Non-Profit (Non-Religious)
Professional Sports Organization
Corporate Organization
Other:
Company Address
*
Your answer
Event Details
Event Budget for Speaker
*
Your answer
Venue Name and Address
*
Your answer
Will tickets be sold for this event?
*
Yes
No
Planned Number of Attendees
*
Your answer
Will this event be open to the public?
*
Yes
No
Do you intend to record or livestream this event?
*
Yes
No
Presentation/Speech Details
Event Start time
*
Time
:
AM
PM
Event date
*
MM
/
DD
/
YYYY
How long would you need Corey to speak?
*
15 Minutes
30 Minutes
1 Hour
Would prefer to discuss with a representative
Topic Requested for this Presentation
*
Workplace Resilience
Becoming Burnout Proof (Burnout Prevention)
Career Strategy
Mindset Reset
Other:
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