Winner’s Circle Coaches Corner Intake Form

First Name

Last Name

Phone number

Email Address

Address

City

State

Zip Code

Area of Expertise

Your professional title

Biography

Website (if applicable)

Social media handles (links preferred)

Twitter:

Facebook:

Instagram:

LinkedIn:

By Submitting this form, you agree to the following:

I will conduct one live workshop, training or coaching session in the Winner’s Circle Community each quarter

Yes

No

Please provide your Four workshops, trainings, or coaching topics (tittle of message) you will be speaking on.

(Please note: the objective of your message must educate, inspire, motivate and/or serve as a valuable resource. You may also update or change a topic at anytime before it is presented)

Please provide your Four workshops, trainings, or coaching topics (title of message) you will be speaking on. For each topic, please provide a brief description or learning objective.

Topic 1 plus Learning Objective

Topic 2 plus Learning Objective

Topic 3 plus Learning Objective

Topic 4 plus Learning Objective

As a WILDE Winner’s Circle Coach, I am committing to my own personal and professional development, and that of my fellow Coaches. I will participate in a Pow Wow with all the Coaches (members may be invited to attend) each quarter.

Yes

No

I will conduct one live video session in the Winner’s Circle Facebook Community each quarter to (re)introduce myself to the members.

Yes

No

I will remain an active contributor to the WILDE Winner’s Circle online community, and act as both a conversation starter, and someone who engages in ongoing conversations.

Yes

No

Profile Picture

Please upload a high resolution picture, or email your picture to info@wildeinc.org (will be used for your wilde.org profile and other PR graphics). Formats allowed are: jpg, png, pdf