Application Form

Millennial Women's Mastermind

Application Form
Name*

First NameLast Name
E-mail*
How long have you been in business full-time?*

10-12 months7-9 months4-6 months1-3 monthsI just quit my 9-5!I'm still in my 9-5...Other
What is your average monthly income? Please only include income from your business; do NOT include supplemental income, gifts, or rebates.*

under $1000/month$1000-$3000/month$3000-$5000/monthover $5000/month
Please select all that apply to you:*

I am a millennial (born between 1984-1996)I do NOT have childrenI am NOT marriedI am NOT married yet, but plan to be married in the next 9 monthsI was born before 1986, but still identify as a millennialI have childrenI am married
Please describe your business and current offers/packages:*
What are your three main business goals of 2019?*
Please describe your 10-year vision for your business and life. Feel free to include all the details!*

On a scale of 1-10, how committed are you to growing your business and bringing your vision to life?*

	1	2	3	4	5	6	7	8	9	10

1 is Not Committed, 10 is Totally Committed

Please explain why you chose the rating from the question above:*
What is your biggest struggle in growing your business right now?*
The Millennial Women's Mastermind is a group-centered experience with elements of 1:1 coaching. What do you desire to get out of this experience? *
Do you understand that the Millennial Women's Mastermind is an investment of $5,000 if paid in full (or six equal payments of $947)?*

YesNo
Is there anything else you want Jackie to know before you connect on your discovery call?
Should be Empty:

Millennial Women's Mastermind