Primary Contact Information
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First Name
Last Name
Primary Contact Email
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Primary Contact Phone/Text
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Country
(###)
###
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Organizational Details
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Denomination
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PC(USA) – Presbyterian Church (USA)
African Methodist Episcopal Church (AME)
African Methodist Episcopal Zion Church (AMEZ)
American Baptist Churches (ABC-USA)
Christian Church (Disciples of Christ)
Cumberland Presbyterian Church
Episcopal Church (TEC)
Evangelical Covenant Church
Evangelical Lutheran Church in America (ELCA)
Evangelical Lutheran Synod (ELS)
Free Methodist Church
Interdenominational / Ecumenical Organization
Mennonite Church USA
Moravian Church in America
Non-Denominational Christian
Progressive Baptist Churches
Reformed Church in America (RCA)
Unitarian Universalist Association (UUA)
United Church of Christ (UCC)
United Methodist Church (UMC)
Quakers (Friends General Conference, Friends United Meeting, etc.)
Other
Other: Denomination
Team Size
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1 - 10
11 - 50
51 - 100
101 - 500
501+
Country Location if In-Person Event:
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United States
Canada
Europe
Asia
Australia
Not Applicable - No Travel Required
Other (please specify)
Other: Country Location
Event Location:
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Auditorium/Hall/Gym
Church Sanctuary
Corporate Setting
Event Center
Hybrid on Location
Retreat Center
Seminary
Virtual Live
Virtual Pre-Recorded Content
Other
Other: Event Location
Type of Program or Service Requested
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Check All That Apply
Other: Type of Program Requested
Other: Custom Keynote or Workshop
Program Duration
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Check All That Apply
Other: Custom Program Duration
Which Program Aligns with Your Needs?
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Check All That Apply
Other: Which program aligns with your needs?
Primary Goals for This Program
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Check All That Apply
Other: Primary Goals for This Program
What are the biggest struggles or pain points for your clergy, leadership, students, teams, or congregation right now?
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Check All That Apply
Other: What are the biggest struggles or pain points for your clergy, leadership, students, teams, or congregation right now?
Preferred Start Date or Timeline:
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ASAP
Within 1–3 months
Within 3–6 months
Within 6-9 months
Within 9-12 months
12 months +
Flexible timeline
Other (please specify):
Other: Custom Preferred Start Date or Timeline
Will your organization cover travel expenses for in-person engagements?
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Yes, all travel and accommodations will be covered.
Yes, partially covered
No, looking for virtual options
Estimated Budget for This Program:
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< $5,000
$5,000 - $10,000
$10,001–$20,000
$20,001–$30,000
$30,001–$50,000
$50,000+
Custom Budget – Let’s Discuss
Will your organization require invoices or additional documentation before confirmation?
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Yes, a formal invoice is required
No, payment can be processed upon agreement
Pre-Retreat Equipment & Resource Assessment
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To ensure a smooth and fully equipped experience, please indicate which of the following resources your church or venue can provide. This helps us determine any additional equipment or materials I may need to bring to best serve your group.
Audio/Visual (A/V) & Technology Setup (Check all that apply)
Additional: A/V & Tech Resources Information
Is there anything else we should know about your A/V & Tech resources, expectations, or needs?
Lighting & Room Setup (Check all that apply)
*
Additional: Lighting & Set Up Resources Information
Is there anything else we should know about your lighting & set up resources, expectations, or needs?
Whiteboards, Visual Aids & Writing Materials (Check all that apply)
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Additional: Whiteboards, Visual Aids & Writing Materials Resources Information
Is there anything else we should know about your Whiteboards, Visual Aids & Writing Materials resources, expectations, or needs?
Wellness & Engagement Resources (Optional Activities & Self-Care Stations)
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Additional: Wellness & Engagement Resources Information
Is there anything else we should know about your Wellness & Engagement Resources, expectations, or needs?
How Did You Hear About My Coaching & Retreat Programs?
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Advertisement
Email List
Newsletter
Podcast (specify episode if possible)
Referral (friend, colleague, or client, please specify)
Social Media (LinkedIn, Instagram, etc. please specify)
Speaking event/workshop
Website/blog
Other
Other How did you hear about my coaching services?
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Acknowledgment
*
✔ I understand that this application is part of a selection process and that coaching is a professional relationship, not a substitute for legal, medical, or mental health advice.
✔ By booking services with The Charlie Hornes Coaching Studio, LLC, you confirm that you have read, understood, and agree to these Terms and Conditions. You also acknowledge the refund and cancellation policies outlined herein.
✔ I acknowledge that this retreat or training is customized based on our needs and requires planning and preparation. Last minute changes or requests may not be adhered to.
✔ I confirm that the information provided above is accurate to the best of my knowledge.
Terms and Conditions
*
Acknowledgment and Agreement that you have read and agree to the Terms and Conditions
You can find this at: https://charliehornescoaching.com/disclaimer
By booking services with The Charlie Hornes Coaching Studio, LLC, you confirm that you have read, understood, and agree to these Terms and Conditions. You also acknowledge the refund and cancellation policies outlined herein.
For questions, cancellations, or refunds, contact us at: support@charliehornescoaching.com
Please type your legal name in acknowledgement as the primary contact for your Organization
*
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