EmailMeForm
Your Name as you would like it to appear on the website:
Preferred gender pronoun:
A preferred gender pronoun (PGP) is a pronoun an individual chooses to identify with and would prefer others use when talking to or about that individual.
For example, She, her, hers, he, him, his, they, etc...
Business/Organization:
Your Title:
Email
Where can we direct our listeners to get in touch with you? (Your Website?)
Cell:
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Facebook Page or Name
If applicable. Your information will be used to connect you to the podcast on your social media sites when the episode has launched.
Twitter
If applicable. Your information will be used to connect you to the podcast on your social media sites when the episode has launched.
Instagram
If applicable. Your information will be used to connect you to the podcast on your social media sites when the episode has launched.
Skype Name/Affiliated Email Address
For those who will be interviewed but are not local to the Atlanta area.
We want to promote your episode and YOU as effectively as possible! To that end please provide us with your Logo, headshot, images of you speaking/training, and a photo of you following your passion or doing something you love (candid shots are fine).
For guests in the Atlanta area, are you interested in a FREE professional photo?
Yes
No
If so, we can schedule time before the podcast recording to have your photo taken by BlackVign's photographer and socially engaged artist.
Photo's will be used as we promote your episode and included in BlackVign's archival project.
Short bio and current focus:
If you have a bio already written in a document, you can attach it here:
Some of your key accomplishments you would like to share:
Leadership Lessons you would like to Share:
Top 3 areas of interest to talk about:
Leadership Begins at Home
Is Character Relevant to Leadership?
Building Trust in Groups
Keeping Members Motivated
Generating Innovative Ideas
Authentic Leadership/ Being Your Authentic Self
Self-Reflection and Feedback
Dealing with Difficult People
Leading and Managing Change
Emotional Intelligence
Gender in Leadership
Sexuality in Leadership
Servant Leadership
Entrepreneurial Leadership
Learning from Failure
Communication in Leadership
Leadership in Community Engagement
How to Deal with Stress, Anxiety and Envy
Leadership in Crisis Situations
Sacrifices of Leadership
Aligning Purpose with Action
Knowing Yourself to Lead Others
Self-Care in Leadership and manageable techniques
Discovering Your True Passion
Mentorship in Leadership
What is one book, movie, television show, tool or resource that you would recommend to everyone listening right now to help them grow in the coming year?
Is there anything in the news/media that is interesting to you or that you are passionate about that you would want to discuss or talk about?
Do you have any specific questions you'd like to be asked during the show?
Which times work best based on your availability for the interview?
(check all that apply)
morning
afternoon
evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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