Personal Information

Address

Street Address

City

State

Country

Postal code

Professional Background

Your Current Role or Business Title:

Brief Professional Bio (100–150 words):

Link to Speaker Reel or Featured Media (if any):

Your Vision

Why do you want to co-author a book with Les Brown?

What message or story would you like to share in your book?

Commitment & Investment

Is there anything else you’d like us to know about you or your goals for this project?

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