settings
First Name
settings
Last Name
settings
Email
settings
Cell Phone Number
settings
Instagram Handle
settings
What is the name of your business?
settings
Physical Mailing Address (Where we can send you stuff)
settings
Physical Mailing Address 2
settings
City
settings
Select...
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D.C.
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Mexico
New Jersey
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
(AU) Australian Capital Territory
(AU) New South Wales
(AU) Victoria
(AU) Queensland
(AU) Northern Territory
(AU) Western Australia
(AU) South Australia
(AU) Tasmania
(ZA) Gauteng
(ZA) Western Cape
(ZA) Eastern Cape
(ZA) KwaZulu Natal
(ZA) North West
(ZA) Northern Cape
(ZA) Mpumalanga
(ZA) Free State
My State is not listed
State
settings
Zip Code
settings
Birthday
settings
What's your t-shirt size?
settings
Number of years in business
settings
Do you operate your business while working a full time job?
settings
What is your biggest frustration in your business right now?
settings
Select...
0-20,000
20,001-40,000
40,001-60,000
60,001-80,000
80,001-100,000
100,001 or more
What was your revenue for the past 12 months?
settings
What is your 2022 revenue goal?
settings
What's your vision for your life and your business?
settings
Select...
1 - Extremely Committed
2 - Very Committed
3 - Committed
4 - Somewhat committed
5 - Not very committed
How would you describe your level of commitment to your personal and professional goals?
settings
Why do you believe you are ready to join a mastermind?
settings
Select...
Yes
No
If accepted in the CEO Collective Mastermind, are you prepared to start now?
settings
Select...
Yes
No
Do you understand that there is an investment in the CEO Collective Mastermind if you’re accepted?
settings
SUBMIT
[bot_catcher]
