Consultation Intake Form

Please fill out the fields below. This form is used to help Michele gain an understanding of your needs and will be used during your consult session.

Consultation Intake Form

Name(Required)
Location of proposed event
Type of event

Please select one. This applies to the format of your proposed event. Please select the option you feel most appropriately represents your event.
Content areas
Please select the following areas of content you are interested in for your speaking or training event. Check all that apply.
MM slash DD slash YYYY
Please indicate the date(s) of your proposed speaking or training event.
Please indicate the length of time you have allotted for this event.
Please indicate the number of people who are involved in your event.
This field is for validation purposes and should be left unchanged.