Name *

First Name

Last Name

Phone

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Agreement *

By submitting this form, I acknowledge the following: Confidentiality All information shared will be held confidential and will not be disclosed. These obligations continue beyond the end of our work together. Indemnification Each party agrees to hold the other harmless against claims arising out of their own actions or omissions. Communication Conscious Revolution commits to being prompt and responsive. Timeliness and quality of support depend on clients providing accurate and timely information. We’ll collaborate on a communication schedule that works for both parties. Scope of Services Conscious Revolution provides facilitation, coaching, advising, and organizational support—but does not provide legal advice. Clients are responsible for securing legal counsel if needed. Intellectual Property Materials created by Conscious Revolution remain our intellectual property. Clients are granted permission to use these materials for internal organizational purposes.

I acknowledge.

Within what timeframe do you need this issue addressed? *

Conscious Revolution will assess capacity and confirm next steps after reviewing this form. We will be back in touch based on your timeframe needs.

24 hours

48 hours

72 hours

One week

More than one week