First, I meet with the stakeholder(s) in order to discuss the audience, topic, and intention of the ad campaign. I like to generate 2-3 directions for imagery, and to do that, I sketch anything relevant that comes to mind. Once those directions are ready for feedback, I share them with other visual designers to determine what's working and what isn't. Then, I meet with the stakeholder(s) for their feedback. Based on that discussion, I continue to iterate on the creative until I land on a successful piece of work.
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