Full Name *

Your Business Website *

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

Phone Number *

Mailing Address *

Have you ever been apart of a mastermind before? If yes, tell us about that experience. What did you takeaway or enjoy most? Was the mastermind free or paid? Was it a mastermind created by peers or a mentor? *

Tell us more about your business(es) and who you serve. *

Describe your current offers or products and price points. What is your best seller? *

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. *

How did you hear about Small Business Powerhouse™ Mastermind? *

Put a check box for everything you currently have in place and are utilizing in your biz... *

What do you hope to get out of this mastermind? *

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

If you do not get accepted into Small Business Powerhouse™ Mastermind, 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 Small Business Powerhouse™ clients come directly from Foot Traffic Formula™. *

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? *