Expert Support Session Booking Form

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Please complete this form if you are interested in Coaching for Impact with Alexandra Smith or Mentoring for Success with Warren Koehler.

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1. Your Name *

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2. Position within Organisation *

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3. Charity/Organisation Name *

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4. Organisation type e.g Charity / CIC / CIO / Community Group *

5. Charity Number/ HMRC Exemption Number/CIC Number

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6. Organisation Income *

Less than £10,000
£10,000 - £25,000
£25,000 - £50,000
£50,000-£75.000
£75,000 - £100,000
More than £100,000

7. Which Community Board area(s) do you DELIVER services to? Please tick all that apply.
If you are unsure of which area(s) to select, click on link below.

https://www.buckinghamshire.gov.uk/community-and-safety/improving-your-local-community/find-your-local-community-board/

Outside Buckinghamshire
All of Bucks
1. Buckingham and Villages
2. Winslow and Villages
3. Wing and Ivinghoe
4. Haddenham and Waddesdon
5. Aylesbury
6. Wendover
7. Chesham and Villages
8. Missendens
9. North West Chilterns
10. Amersham
11. South West Chilterns
12. Beaconsfield and Chepping Wye
13. High Wycombe
14. Beeches
15. Wexham and Ivers
16. Denham and Gerrards Cross and Chalfonts

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8. Organisation Address *

9. Website

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10. Contact Phone *

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11. Contact Email *

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12. Please indicate whether you have a preference for phone or zoom/teams meetings. *

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13. Session you are interested in *

Coaching for Impact with Alexandra Smith
Mentoring for Success with Warren Koehler

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