Mastermind Interest Form

Thank you for your interest in joining one of our Mastermind Communities! Please complete the information below so I can learn more about your desired goals and specific needs.

Please note that by submitting this form, you are expressing interest in learning more about our Mastermind Communities and there is no obligation to officially register.

Additional details about upcoming sessions and registration will be shared via email once we receive your information.

Client Information

First Name

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Last Name

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Email Address

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Phone Number

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Best time to call (Please check all that apply)

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Current Location

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Employer + Title of Role

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Mastermind Information

Have you ever participated in a Mastermind group before?

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If you responded yes above, please share more about the program you participated in and your experience. What do you like most (and least)?

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When do you ideally want to join a Mastermind Community?

Each new group lasts three months and they start periodically throughout the year based on interest and availability.

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If you need financial support, please share more about your specific situation and the amount you can afford monthly.

A limited number of scholarship spots are available at significantly reduced rates for individuals in need and each will be reviewed accordingly.

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Desired Goals + Outcomes

What is your primary interest for joining a Mastermind Community at this time?

Please check all that apply or add your own option below.

I want to expand my network of like-minded professionals
I can't seem to get started on a specific goal
I need more support and accountability
I'm ready to make and sustain some changes
I am curious about coaching and wanted to try out a group experience
Other:

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What issues are you currently facing that you're seeking support for?

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Please describe any desired solutions or specific goals more in depth here:

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If you are interested in learning more about any other custom leadership solutions, please check all that apply below:

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Do you have any specific questions I can respond to before you join a Mastermind Community?

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Please share anything else I should know before we connect here:

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What People Are Saying About Lead With Intention™

Learn more about what past clients have experienced when we've partnered together!