About You

*Please do not initiate discussions about religion or politics

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

Country

Website *

For Our Discussion

What is your desired topic of discussion that speaks to the internal shifts necessary for visionary leaders and entrepreneurs to elevate their legacy, impact, influence, and leadership? *

Do you have any topics or questions you'd like Alan to discuss or ask? Or any you prefer NOT to include in the conversation? *

What is your business? *

How do you serve your clients? *

Share your social media username for each platform you'd like to be tagged on. (FB, IG, LI, YT, TikTok) *

Please share your official Bio below. You're welcome to paste the text or a link to the bio. *

Share the link to your headshot (shared drive) or upload the file below. Type SEE BELOW if adding the file. *

Upload your headshot