Impact Council Application
Complete this short application to confirm fit for the peer mastermind and schedule a brief follow-up fit call.
Applicant Information
Full name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Program Fit and Business Profile
Which group are you applying to?
*
Please Select
Impact Council ($500K-$2M revenue)
Impact Summit waitlist ($2M+ revenue)
Not sure - place me after a fit call
Business name and what it does
*
Approximate annual revenue
*
Please Select
Under $250K
$250K-$500K
$500K-$1M
$1M-$2M
$2M-$5M
$5M+
Years in business
*
Please Select
Under 1
1-2
3-5
6-10
10+
Employees and contractors besides yourself
*
Please Select
0
1-4
5-15
16-50
50+
Is this your full-time primary business?
*
Yes
No
Revenue over the last 12 months
*
Growing
Flat
Declining
Is the business currently profitable or at break-even?
*
Yes
No
Not sure
Motivation, Commitment, and Contribution
What is the single biggest challenge or opportunity you want to work on over the next six months?
*
What would make this group clearly worth the investment for you?
*
Can you commit to attending both monthly sessions and participating in the group chat for a full six-month term?
*
Yes
No
What can you bring to the group: experience, perspective, or resources other owners would value?
Submit application
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