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Leaders Create Leaders Mastermind Assessment Form
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14
Questions
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1
Name
*
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First Name
Last Name
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2
Email
*
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example@example.com
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3
Phone Number
*
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Please enter a valid phone number.
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4
Instagram Handle
*
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5
Do you have a tribe that is growing and supporting you?
*
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YES
NO
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6
What type of business do you own?
*
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7
Why are you applying for this mastermind?
*
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(Please be detailed)
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8
What has recently been holding you back from your next level of growth that you would like to overcome?
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9
What outcome would be priceless to you? What does success look like to you?
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(Please be descriptive)
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10
What is your average monthly revenue in USD?
*
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Less than $5k
$5k - $10k
$10k - $25k
$25k - $50k
$50k - $250k
$250k +
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11
If our program is aligned with your goals and you're willing to invest in yourself / your business, when do you want to start?
*
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Today
Within a week
In the next few months
Not ready
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12
How Did You Hear About Us?
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13
The people who receive the best results for their business typically are willing to invest a minimum of $5,000. Is that you?
YES
NO
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14
Please submit a $200 refundable deposit today. On the next page you’ll schedule a call with Gerard to finalize your Discovery Call.
Your credit card will be charged: $200.00 We never store your card number or CVC number
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ORDER SUMMARY
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Conscious Leaders Mastermind Discovery Call Refundable Deposit
Conscious Leaders Mastermind Discovery Call Refundable Deposit
$
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