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Client Registration Form
Please take a moment to complete this registration form. It is designed to help Embodied Minds prepare you in meeting your public speaking goals. If a particular question does not apply to you, you may answer “N/A”.
*How did you hear about us?
*1. What motivated you to sign up for public speaking sessions?
*2. Indicate the level of anxiety you experience while presenting in front of an audience:
4 Extremely High
One must learn to crawl before they can walk. One must learn to walk before they can run. Short-term goals (i.e. speaking up in work meetings) and long- term goals (i.e. presenting in front of a large audience) should be realistically attainable to ensure one’s success.
*3. What is your short-term public speaking goal?
*4. What is your long-term public speaking goal?
Presentation Details (Please complete if applicable):
1. What are the main goals/objectives of your presentation?
2. What is the title/topic of your presentation?
3. When will your presentation take place?
4. Where will your presentation take place? Please include multiple locations if applicable.
5. How long is your presentation?
6. Will any breaks be included?
6a. If “Yes”, approximately how long?
7. Please specify any presentation aids or materials you will be using (ie. PowerPoint, clicker, microphone(s), pictures, videos):
8. What is the dress code for your presentation?
9. Anticipated number of audience members:
10. Estimated age range of audience:
11. Will there be any “special guests”?
12. Is the audience attending your presentation?
Thank you for taking the time to complete this form.