Intake Form

Please tell us a little bit about you and we'll get back to you within two business days.




Location (City, State)


Phone Number

Event or conference title

Specific date or time frame

Debby’s visit will be done in conjunction with a community-wide read of Waking Up White

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Audience Members/Participants (check all those that apply)

Board of DirectorsCivicCorporateEducationEmployeesFaculty & AdminFaith CommunityHealth CareLeadership/ManagementNot-for-Profit/GrassrootsParentsStudentsOther (Please describe)

I am interested in:

Keynote Address - Debby will craft an address specific to the theme of your eventCommunity Presentation and Dialog - Appropriate for wide-range of participants and customized for learning objectiveProfessional Development Workshop / Training - Appropriate for wide range of participants and customized for learning objectiveOne-on-One Leadership Consulting - Can be done by video, phone or in personOrganizational Consulting - Ongoing engagement. Minimum 25 hours per year