Impact Roundtable Application
Apply to join a six-month peer group for independent professionals and small practices.
Applicant Information
Full name
*
First Name
Last Name
Email
*
example@example.com
Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Business Profile
Business name and what it does
*
Approximate annual revenue
*
Please Select
Under $100K
$100K-$150K
$150K-$250K
$250K-$400K
$400K-$500K
$500K or more
Years in business
*
Under 1 year
1-2 years
3-5 years
6-10 years
10+ years
Team size besides yourself
*
Solo
1-2 helpers or contractors
3-5
6 or more
Goals and Commitment
What is the biggest thing you want to grow or fix over the next six months?
*
What would make this group clearly worth the investment for you?
*
Can you commit to a full six-month term, including the monthly growth session and the twice-monthly accountability pod meetings?
*
Yes
No
What can you bring to the group: experience, perspective, or resources other members would value?
Submit application
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