Let's Co-Create Your Experience Bring a Dr. Jennifer Keitt Experience to your Organization Question Title How did you hear about Dr. Jennifer? I saw Dr. Jennifer speak Referred by someone Online search Social media Other (please specify) Question Title Client Information Point of Contact Name Company/Organization Email Address Phone Number Engagement Details Question Title I am interested in a In-Person Keynote Virtual Keynote Other (please specify) Question Title Budget Question Title Number of Participants Logistics Question Title Potential Date(s) Question Title Location Audience Information Question Title Is your group predominantly Female Male Mixed Gender (Female & Male) Question Title What is your group's predominant experience level? High School Students Emerging leaders - college students, interns, and entry-level professionals Soaring Leaders - professionals with less than 10 years of experience Seasoned Leaders - professionals with 11 or more years of experience Sage Leaders - professionals with 20 or more years of experience I'm not sure Question Title What are the most significant needs of your group? Question Title What topic do you have in mind? Question Title What outcomes do you want for this experience? Inspiration Interaction and Engagement with each other Increased Motivation Learn something new Ask questions and get answers Things to Note The requested dates are not held without a 25% deposit. Travel compensation is required for in-person experiences. This includes airfare, hotel accommodations, ground transportation, and expenses. Dr. Jennifer will conduct one (1) 15-minute Meet & Greet. Dr. Jennifer will conduct one (1) Booking Call after receiving a deposit and signed contract. Question Title Additional Comments Connect With Us Question Title Newsletter Opt-In I'd like to subscribe to your newsletter Done
