My Public Image™

The Leadership Presence Program™

Media Training for Every Platform, Communication for Every Room™

Application Form

Name

First Name

Last Name

Phone

(###)

###

####

LinkedIn Profile (or personal website)

Your current role and organization

Where are you based? (City, Country)

What is your current leadership role, and how are you being—or not being—seen?

(What visibility gap, challenge, or opportunity are you navigating right now? Max 250 words)

Which visibility moment are you preparing for (or navigating now)?

Check all that apply

Media

Speaking

Board appointment

Leadership transition

Reputation reset

Other...

Why is this the right season for you to step into greater visibility and voice?

(What’s shifting in your leadership or goals that makes this moment essential? Max 250 words)

What would a successful outcome from this program look like for you?

(e.g., capital, keynote, board positioning, brand clarity)

Which cohort format aligns best with your schedule, needs, and learning style?

Confirmation Checkbox:

I understand that participation is by invitation only, and completing this form does not guarantee acceptance.

Agree

I have read, understood, and agree to be bound by Boss Women Your Public ImageTM Terms and Conditions.

Terms and Conditions

This is an executive-level leadership experience.
We accept a limited number of participants per cohort to maintain depth, discretion, and strategic alignment.

Please complete the application below. You will be contacted directly if selected to move forward.

My Public Image™

The Leadership Presence Program™

Media Training for Every Platform, Communication for Every Room™

Application Form

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