Extreme Leadership Accelerator: mastermind registration form

Welcome to the EXTREME Leadership Accelerator.

The following membership registration is a vital part of the mastermind process.

The information will be used to select and place you in a mastermind cohort of 4-7 people - who will support your journey for the remaining year.

Even if you are part of an in-house company program, please complete all form elements unless they don't apply to your life circumstance.

Move quickly through the questions; it's not about the perfect answers; it's about getting to know you authentically.

KEEP YOUR BROWSER WINDOW OPEN

IF YOU EXIT OR REFRESH YOUR BROWSER BEFORE FINISHING, YOUR WORK WILL NOT BE SAVED

YOU MAY WISH TO WRITE YOUR ANSWERS IN A SEPARATE DOCUMENT AND CUT AND PASTE THEM (not required, but it is the best practice not to lose work).

Name

First Name Last Name

Email *

example@example.com

Business Name

Business Website

Facebook (if you have).

LinkedIn Profile Link

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

What time zone are you in?

Phone Number

Area Code Phone Number

What is your preferred time for meeting with your group:

AM Afternoon Evening No preference

Who invited you to join and/or how did you learn about this program?

T-shirt size

What is your primary reason for joining the EXTREME Leadership Mastermind Accelerator?

What is the number one way that you will contribute and give back to the members of this community?

If there was one primary life goal (main project, purpose, or challenge) that being in this group could help you achieve - what would that be?

What are your three most potent and powerful superpowers?

These are your gifts and talents that when you use, the world wins.

What is current primary business activity, and what industry are you in?

Describe your current customers - which people/industries do you primarily serve?

Briefly describe your work history - including major milestones and events, or provide an appropriate link to such.

Links to an online profile with history work great.

List three interests that you are most passionate about.

Name three songs you love and include the artists that perform them.

Name three topics you LOVE to talk about; and three topics you prefer to avoid.

Name three living people that you'd love to learn from or interview about their life.

In which ways are you Cultivating LOVE and making this world a better place?

How are you Generating Energy in a way that contributes positively to your environments?

How are you Inspiring Audacity?

How are you providing Proof in living in alignment with your values and gifts in a way that benefits the world?

Are there specific people within the Extreme Leadership Community that you would LOVE to be grouped with?

Do you have people in your network that you would like to invite to be a part of the mastermind group this year? If yes, who?

If you are part of an inhouse company program - this does not apply.

Are you interested in being considered to Chair this year?

Yes please. No. I already expressed my interest.

Select the option that best describes your frequency of action with these Extreme Leadership practices:

	Rarely	Sometimes	Most Times	Always
Cultivate Love: I am cultivating love within my team, customers, and partners in how I show up, lead, serve, and act.
Generate Energy: I am generating energy within my team, customers, and partners in how I show up, lead, serve, and act.
Inspire Audacity: I am inspiring audacity within my team, customers, and partners in how I show up, lead, serve, and act.
Provide Proof: I am providing proof to my team, customers, and partners in how I show up, lead, serve, and act.

Describe what you feel will be your number one leadership challenge in the following year:

Upload a picture of yourself and don't be afraid to make it a fun one.

Record, in 3-minutes or less, a brief introduction, include: your name and why you're excited to be joining the EXTREME Leader Accelerator this year.

Living L.E.A.P.

Cultivate LOVE.

Generate ENERGY.

Inspire AUDACITY.

Provide PROOF.

This program unites individuals around the shared value base of L.E.A.P.

This is a membership of active engagement.

The Extreme Leadership Institute does not provide any warranty or guarantee your outcomes.

Refunds requests are processed at the sole discretion of the administration of the Extreme Leadership Institute.