Request to join a Leadership Circle
Help me understand your needs and confirm that the Leadership Circle is right for you!

Of course, this information will only be used to handle your inquiry. There is no cost or obligation. No spam, no unwanted emails. My word on that!

I will contact you within a business day or two about your request.

About You
This is so I can contact you
Name *
Please include your full name
Your answer
Email *
I will reach out to you at this address - please ensure that it is correct!
Your answer
Phone number
Please use smart phone format including country code, e.g. +41-44-123-4567
Your answer
Address *
Plesse include City and Country
Your answer
Introduction *
Please introduce yourself! Who do you work for? What is your role?
Your answer
Your Goal *
What do you want to achieve by participating in this program? Please explain in two or three sentences.
Your answer
Focus *
Currently there are three groups. Which group best meets your needs. If none, please give me a hint, what would help?
Required
Is this program right for you?
A Leadership Circle is most effective when the right people are in the room. Are you one of the right people?
Right role *
Do you have a Scrum leadership role, or a formal or informal leadership role in your company?
Influence *
How many people are in your sphere of influence at work? For example: If you are a manager, how many people are below you in the org chart? If you are a Scrum Master, Product Owner or Agile Coach, how many people are in the team(s) you work with. If you are an senior executive, how many people are in your branch or division? If none of these examples fit, please explain below.
Serious *
Are you serious about wanting to create a high performance team or organization?
Vendor *
Is your employer a vendor of consulting of coaching services (especially Agile related services)? If yes, I need to understand you situation better
Really serious? *
Can you commit to participating actively every month?
Knowledgeable *
Have you taken any Agile training courses, (e.g. Scrum, Kanban, Management 3.0, SAFe, Personal Agility), and are you keen to build on that knowledge?
Finances *
Do you understand that the Leadership Circle is supported by membership fees? If you are requesting a free membership, then please explain your reasons below.
Ready to try it *
Would you like an invitation to our next trial session?
Needs Discussion
Anything we need to discuss? Anything else you you'd like me to know? Please explain any responses that "need discussion." And is there anything else we need to know?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.