4-Part Public Speaking Workshop© Intake Form
To ensure that this workshop is right for you and works with your schedule, we ask that all prospective members to complete the Intake Form.
Once we have a full cohort of 10 participants, you will be notified of the workshop schedule (time/dates) and will be invited to officially join the upcoming cohort by completing your payment.
If you have any questions about the 4-Part Public Speaking Workshop©, please contact us as
We look forward to training with you!
What is your first and last name?
What is your email address?
Which city do you live in? This is so we know your time zone.
Please select the reason that best describes why you are interested in this workshop?
I want to boost my confidence and reduce my feelings of nervousness and anxiety
I want to nail an upcoming presentation
I want to be able to say 'yes' to any speaking opportunity that comes my way at work
I want to deliver a formal speech (e.g. TEDx Talk, wedding speech)
On a scale of 1-10, what is your proficiency level?
Beginner - I can hardly speak in a small group.
Expert - I've can easily deliver a presentation to over 500 people.
What is the best time of day for you to train? Please select all that apply.
Mondays (7AM - 9AM)
Mondays (5PM - 9PM)
Tuesdays (7AM - 9AM)
Tuesdays (5PM - 9PM)
Wednesdays (7AM - 9AM)
Wednesdays (5PM - 9PM)
Thursdays (7AM - 9AM)
Thursdays (5PM - 9PM)
Fridays (7AM - 9AM)
Fridays (5PM - 9PM)
Saturdays (7AM - 12PM)
Sundays (7AM - 12PM)
Is there anything else you would like to share with us?
How did you hear about us?
Word of mouth (friend/colleague)
Another Organization (YWiB, SWIST)
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This form was created inside of Speak for Success.