WIRED Collective Registration Form

Collective Membership
- $190/mo membership fee
- One 3-hour facilitated in-person or virtual session per month
- Proprietary foundational WIRED Connect framework
- Collective members only community events & workshops
- The membership term commitment is 12 months
Did you know your employer can add this as a benefit for learning & development?
Do you want to be part of a virtual or in-person collective?
Collective Membership Application

Complete the form below to sign up for a Collective membership.
Name

First NameLast Name
E-mail
Company and Title
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
1. What is your primary objective or goal for joining a WIRED Collective?
2. What do you believe makes an effective peer group, and what are your expectations?
3. What do you hope to achieve personally or professionally by participating in this collective?
4. What industry do you work in?

Other
5. What function does your position fall into?

Other
6. Do you prefer to be in a group with people in your same function, or with cross-functional roles?
7. Would you like to be in a group specific to any of these areas?
8. Are there any specific topics or themes you'd like to see covered?
9. Do you have any personal or professional experiences that you'd like to share with the group, or any specific skills you would like to offer for the benefit of others?
10. What are your passions and hobbies? What do you love to do in your free time?
11. What kind of books, movies, or music do you enjoy? Do you have any favorites?
12. Are there any causes or issues you're passionate about or actively involved in?
13. What's something you wish more people knew about you or understood better?
14. What challenges, obstacles, or limiting beliefs are you facing that you hope to work through as part of the group?
15. In your opinion, what would make a great facilitator?
16. What resources, tools, or platforms do you think would be beneficial for the group's activities or information sharing?
WIRED Commitments
WIRED will recruit and assign Collective members and facilitators based on application process

WIRED will consistently collect feedback to ensure recommendations for improvement and enhancements of the Collective framework are being taken into consideration

Collective groups will remain between 8-10 members

WIRED will ensure all members are acting within the guiding principles
Once you submit your application, we will contact you shortly to complete your membership application & submit payment.

Thank you!
Should be Empty:

Collective Membership

Collective Membership Application

WIRED Commitments