Intake Form Debra AtkinsonSpeaker Interview How, When, and Why Exercise Women 40+ Our time together will be 50 minutes Web conferencing details provided upon confirmation. Please complete this form so we'll be ready at your interview time. Name Email Your website: Who is your marketing contact? Email address of your EA/marketing contact Your speaker bio Your Speaker Image Topic (or suggested title) for your talk 3-5 questions or bullet points for your talk Size of your email list Please just numbers like this: 100000 How do you plan to promote/share the summit? (Promotion dates: April 3-30) Summit dates May 1-7 Your Social Media Handles: Would you like us to reach out about a live on social with Debra to promote? Yes No Send text messages to Please leave just your phone number without spaces 000-000-1234 Submit Answers