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MEMBER APPLICATION

General Information

First Name *

Last Name *

Phone *

Email *

Birth Date *

How Did You Learn About 317 Mastermind? *

If someone referred you, who can we thank?

Company Information

Company Name *

Company Website

Street Address *

City

State

Country

Postal code

Industry *

How long has your company been in business? *

What's your current role in the company? *

In simplest terms, what kind of business do you operate, and who do you serve? *

Are you the sole decision-maker or do you have a business partner? *

Last Year's Gross Revenue *

Your DESIRED annual revenue 2 years from now? *

What's the #1 CHALLENGE/OBSTACLE you're facing in your business right now? *

A Little More About You...

What would you say are your top 3 PRIORITIES in life? *

What is the best INVESTMENT you've ever made and why? *

What are your HOBBIES / INTERESTS? If none, what would you like to explore? *

Do you have a spouse / significant other / children / pets in your life? *

What is your #1 STRENGTH? *

What is your #1 WEAKNESS? *

One WORD that describes you is.. *

Causes you care about: (IE: children, veterans,) *

Confirming The 317 Mastermind is Right for YOU

What is it about The 317 Mastermind that gets you most excited? *

Which organizations, masterminds, or affiliations do you currently invest in? *

Please share specific skills/expertise/connections you can bring to the group. *

Imagine, 12 months from now. You and 317 Mastermind Founder, Tracy Davison are having lunch together. Looking back over the last 12 months of your life, you're now celebrating what you feel has been a MONUMENTAL SUCCESS for you...what has to have happened in your business and/or personal life? *

References

Please provide 2 professional references who can attest to your abilities, accomplishments & integrity.

Reference #2 - First & Last Name / Email / Phone Number *

Reference #1 - First & Last Name / Email / Phone Number *

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