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Contact Information

First Name *

Last Name *

Phone *

Organization *

Email *

Address

Street Address

City

State

Country

Postal code

Event Details

Event Name

Event Date *

Event Location (City, Country, or Virtual) *

Event Website or Social Media Link

Type of Event (Conference, Corporate Workshop, School Event, Virtual Summit, panel, Wellness Retreat) *

Your Audience

Audience Size (Estimated range) *

Audience Description (e.g., executives, educators, entrepreneurs, neurodivergent leaders, wellness professionals) *

What are their main struggles or aspirations?

Your Vision

What is the theme or goal of your event? *

What kind of transformation or message do you want attendees to walk away with? *

Requested Topics

Signature Talks:

From Stress To Success: Managing Burnout in a High-Pressure World

Befriend Your Life: The Pillars of Personal and Professional Growth

Unleashing Your Neurodiverse Superpowers

Characteristics of Successful Women: Thriving with Confidence, Resilience, and Purpose

From Anxiety to Action: Turning Fear into Motivation

From Burnout to High Performance

From Mess to Success: Mastering Executive Functioning for Busy Professionals

Custom Topic-Please describe

Format Preferences

Preferred Session Length (eg 30-min keynote, 60-min workshop, full-day intensive)

Delivery Format:

In Person

Virtual

Hybrid

Will there be a Q&A or breakout sessions?

Q&A

Breakout Session

NON

Q&A and Breakout Session

Budget & Logistics

Speaker Fee Budget

Will travel /accomodations be provided (if in-person)?

Yes

No

Will you provide AV/tech support?

Yes

No

Accessibility & Incusivity

Are there any accessibility considerations you'd like Karolina to be aware of?

Additional Notes or Questions

How Did You Hear About Karolina?

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