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Speaking and Coaching Assessment Form

Tell Us About Your Situation

This is not a generic form. This assessment helps us understand whether we're the right fit to help you, and whether you're genuinely ready to make a change. Please answer honestly.

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Question 1 of 18

YOUR INFORMATION:

Your Name (required)

 

Question 2 of 18

Your Title (required) 

Question 3 of 18

Organisation Name (required) 

 

Question 4 of 18

Email (required)

 

Question 5 of 18

Phone (required)

Question 6 of 18

YOUR EVENT:

Event Name (required)

Event Type: (required)
Leadership Conference / Corporate Retreat / Team Workshop / Wellness Retreat / Fundraiser / Startup Conference / Business Summit / Personal Development / Podcast Interview / Other]

Expected Audience Size (required) [Dropdown: Under 50 / 50-100 / 100-250 / 250-500 / 500-1000 / 1000+]

Event Date (required) [Date Picker]

Location/City (required) [Text Input]

Virtual, Hybrid, or In-Person? (required) [Radio: Virtual / Hybrid / In-Person]

Audience Description (required) [Text Area - 2-3 sentences] Who will be in the room? What is their challenge?

 

Question 7 of 18

 

WHAT'S YOUR PRIMARY NEED?

A

Keynote (45-60 min)

B

Multiple Sessions (2-3)

C

Workshop (90 min - 3 hrs) /

D

Podcast Interview

E

Panel Discussion

F

OTHER

Question 8 of 18

WHICH FOCUS RESONATES MOST?

(Select all that apply)
A

Leadership & Resilience

B

Health & Energy

C

Wealth & Aligned Success

D

Connection & Culture

E

Integrated (All Three)

F

Let us customise

Question 9 of 18

What Transformation Do You Want for Your Audience?

Question 10 of 18

 

Any Specific Topics or Themes?

Question 11 of 18

 

Speaking Fee Budget 

A

€5,000–€10,000

B

€10,000–€20,000

C

€20,000–€30,000

D

€30,000+

E

Let's discuss pricing

Question 12 of 18

Does Budget Include Travel? 

A

YES

B

NO

C

PARTIAL

Question 13 of 18

TRAVEL ORIGIN

Where will I be travelling from?

Question 14 of 18

 

TECHNICAL REQUIREMENTS

(Select all that apply)
A

Basic AV

B

Video playback

C

Live streaming & Hybrid

D

Podcast recording

E

OTHER

Question 15 of 18

TIMELINE FOR DECISION

A

ASAP (2 weeks)

B

Within 1 month

C

1-3 months

D

3-6 months

E

Still exploring

Question 16 of 18

Why Did You Reach Out?How did you hear about me? What made you interested? 

Question 17 of 18

 

What Problem Are You Solving for Your Audience? What is the core challenge your people are facing?

Question 18 of 18

 

Anything Else We Should Know? Any other details about your event, preferences, or requirements?

Confirm and Submit