Surveypoint

Q1

Name*

First Name

Q2

Name*

Last Name

Q3

Brief Bio*

Q4

Upload your headshot*

Q5

What is your approximate list size? (For tracking purposes and event metrics)*

Q6

Have you booked your interview with Lurline yet? If not, please follow this link to schedule as soon as possible - https://calendly.com/lurline1/60min*

Yes I have booked my interview

Not yet, but will do!

Q7

The topic you would like to discuss on the interview (please include any discussion points you would like me to cover)*

Q8

Share the opt-in page to your free gift here:*

Q9

Please share a brief description of the free gift:*

Q10

When will you send your solo email? (Between December 28 - January 10)*

Date

Q11

When will you send your newsletter mention? (Between December 28 - January 10, must be a different date from your solo email)*

Date

Q12

I have read and understand this release and have signed it on:*

Q13

Company*

Q14

Email*

Q15

Speaker Agreement -Form Fill

Name*

Name*

Brief Bio*

Upload your headshot*

What is your approximate list size? (For tracking purposes and event metrics)*

Have you booked your interview with Lurline yet? If not, please follow this link to schedule as soon as possible - https://calendly.com/lurline1/60min*

The topic you would like to discuss on the interview (please include any discussion points you would like me to cover)*

Share the opt-in page to your free gift here:*

Please share a brief description of the free gift:*

When will you send your solo email? (Between December 28 - January 10)*

When will you send your newsletter mention? (Between December 28 - January 10, must be a different date from your solo email)*

I have read and understand this release and have signed it on:*

Company*

Email*

Signed by the Speaker: *