Legacy Impact Community Membership Information Form

Legacy Impact Community Membership Information Form

(We will email to schedule a follow-up meeting)
Date

MonthDayYear
Name

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Best Date and Time to Schedule for follow-up meeting?
Business Information:*
Your Motivation & Interests*
What are the biggest challenges you currently face in your business?
In what areas do you seek support or guidance from the Impact Community? (e.g., networking, mentorship, business development, etc.)
Contribution and Collaboration:

How do you believe you can contribute to the Impact Community?

Are you interested in collaborating on community projects or initiatives? If yes, please specify your areas of interest or expertise:

Preferences and Expectations:

What are your preferred methods of communication? (e.g., email, phone, in-person meetings)

What are your expectations from the Impact Community membership?

Additional Information:

Please share any other information you feel is relevant to your application.

If available, please attach a brief bio or a link to your LinkedIn profile.
Should be Empty: