| First Name: |
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| Last Name: |
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| Company Name: |
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| E-mail Address: |
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| Best Contact Number: |
example: 905-555-1234 |
| City: |
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| State/Province: |
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| Leader's Choice Graduate: |
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| I am interested in becoming a: |
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| What are you doing now? |
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| Have you ever attended any speaker development courses or workshops? If so, which ones? |
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| How many years of paid speaking/training experience do you have? |
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| What organizations have you spoken/trained for? |
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| What are some of the subjects that you've presented? |
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| Do you know your DISC profile? If so, what is it? |
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| What attracts you to the speaking profession? |
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| In what areas do you feel that you could use further speaker development or training? |
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| Please rate your overall speaking/training abilities: Poor, Fair, Good, Very Good, Excellent, Outstanding |
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| Do you have any professional real estate experience? If so, please describe. |
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| Do you have professional references on your speaking experience?
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| How did you hear about Leaders Choice? |
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| Other experience that you feel would help us in considering your application: |
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| Your personal comments, if any, for further consideration: |
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Subject:
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Message:
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| - Email a copy of this to your own address? |
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