Contact Name *

First Name

Last Name

What type of engagement are you interested in? *

Select all that apply.

Retreat Facilitation

Extended Meeting Facilitation

Keynote Speaker

Workshop

Podcast or Radio Interview

Something else super interesting

Are any of the participants or audience members currently enrolled in our Justice at Work online course?

No

Yes - less than half

Yes - more than half

Not sure

Would you like Mia to attend virtually or in-person? *

Please note that travel and lodging is not included in our fees.

Yes

No

Not Sure Yet