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We value your feedback!

The largest room in the world is room for improvement. Thanks for making MODUS better.

Share your experience with us

Which service did you experience?

Corporarte Strengths Training

Executive Strengths Coaching

Guest Speaker

Premarital/Relationship Coaching

Would you recommend this service?

Yes

No

Yes (if changes are made)

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Share what you enjoyed, recommend for improvement, or general feedback!

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Contact Information

First name

Email

Are you the point of contact? If not list the point of contact name.

Business or Organization Name:

Last name

Phone

If you're not the point of contact please provide a name:

Website (leave blank if not applicable)

Event Details

Event Name

Event Time

Event Purpose

Which day(s) will the event take place?

Desired speaking date (subject to availability and confirmation)

Brief event description and/or date range if multiple days are requested:

Is this a recorded event?

Yes

No

How many days will the event tak place?

Single Day

Multiple Days

Is this an in-person, virtual, or hybrid event?

In-Person

Virtual

Hybrid

Is there any fee for attendance?

Yes

No

Audience & Venue Details

Audience Size

Invitation Only or Open to public?

Invitation-Only

Open to public

Event Location

Select the venue that best matches

School Auditorium

Classroom

Sanctuary

Home

Office Conference Room

Hotel Conference Room

Outdoors

Other

Audience Type (e.g., church, business, couples)

Do you have AV available? (projector, handheld, headset or lavelier mic, corded or cordless?

Select all additional items the speaker needs to bring:

Speaking Table

Extension Cord

Projector Screen

Speakers

Flipchart

Whiteboard

Other

No additional equipment will be needed

Do you have Wi-Fi access?

Yes

No

Other things the speaker needs to bring:

What is the amount of time allocated for the speaker? (e.g., 20 minutes, 1 hr, 3 hrs).

Will the speaker need to be present for the entire event?

Yes

No

Presentation/Speech Details

Type of Presentation

Estimated speaking time (e.g., 20 min., 90 min., 3 hrs.)

Select the topic(s) of interest

Effective Communication

Building Trust

Roles & Blindspots

Relationships & Finances

Difficult Conversations

Temperaments & Talent

Relationship Boundaries

Affair Proof Marriage

Other

Is the topic fixed or flexible?

Flexible

Fixed

Do you already have a program or an agenda?

Yes

No

Briefly describe the desired outcome or other topics of interest if different from above:

Thank you! We’ll be in touch.

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