NSA VIdeo Intake Form

GOLD: Strategic Leadership Coaching Amid Accelerating Change Learn More
SILVER: Strategic Leadership Coaching to Reach Your Goals Faster, and Inspire Employees to Make the Necessary Changes Learn More
BRONZE: Fast Track Your Business to the Next Level Learn More

If you have been asked to be a guest as a featured member at NSA Las Vegas, please fill out the form below completely. Once you complete the form, you will receive Dr. Katrina’s Zoom Meeting link.

Guest Information
Guest Name*
First Last
Guest Business Title*
Guest Company or Business Name*
Guest Website
Guest Cell Phone Number*
Email*
Enter Email Confirm Email
Number of followers on social media:*
Facebook URL
Twitter URL
LinkedIn URL
Instagram URL
Short Bio*
150 word or less
Areas of Expertise
You will be asked the following questions for the featured member video:
- What problem do you help your client solve?
- What outcome do you hope your speaking engagements will have? (Ex. Revenue, Growing Your Consulting or Coaching Business, etc.)
- What is your 2021-22 strategy to build your business?
- How can people contact you?
- What has NSA Las Vegas contributed to your career?
What are the three (3) takeaways for the viewers?*
Upload your headshot (High resolutions preferred)*
Drop files here or

Max. file size: 256 MB.
Which of these categories best represents you?*
Special requests or comments*
Do you consent to your submitted data being collected and stored?*
- Yes
I agree to be added to the NSA and Dr. Katrina Burrus, MCC email list. (This way you will know when your episode is published)*
- Yes
Do you allow Dr. Katrina Burrus, MCC to promote your video on her social media platforms?*
- Yes
- No
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NSA Video Intake Form

Guest Information