Full Name *

Your Business Website *

Best email address for Stacy to personally reach out to you? *

Phone Number *

Have you ever been apart of a mastermind before? If yes, was the mastermind free or paid? Was it a mastermind created by peers or a mentor? *

What was your total gross revenue for the last fiscal year? *

What is your total gross revenue projection for this year? *

What are your biggest struggles holding you back from creating the business you desire? *

What are your top 3 goals for the next 12 months? Please include your revenue goal. *

What do you hope to get out of Powerhouse? *

Why do you think Stacy is the right person to facilitate your mastermind group? *

If you do not get accepted into Powerhouse, are you interested in the Foot Traffic Formula program? This program is designed to systematize and scale your business through creating an automated marketing system. Many of our Powerhouse clients come directly from Foot Traffic Formula. Details here: http://foottrafficprogram.com *

Knowing we have a very limited seat count for this program, why do you feel YOU should be one of the ones selected for this group? *