Online Peer Group Application

PLEASE NOTE: THIS APPLICATION IS FOR THE ONLINE VERSION OF THE HTG PEER GROUPS. IF YOU ARE INTERESTED IN THE FACE-TO-FACE VERSION, THIS IS THE WRONG APPLICATION. PLEASE EXIT AND GO TO WWW.HTGPEERGROUPS.COM TO APPLY.

Membership in these online peer groups will be determined by your responses to these questions. Groups will be assembled with companies from non-competing markets. Please use this form to indicate your interest in joining an online peer group. The groups will start in Q2 of 2012. You will be contacted prior to that start to be plugged into a group. (If you have questions send email to asorensen@htgpeergroups.com)

The cost to participate in the program is $100 per month, paid either as $1,200 at the time you start, or $650 if paid in a semi annual option covering six months. Payment must be made by credit card or automatic bank transfer and will happen once you have been placed in a group prior to your first meeting.

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1. Please enter your contact information.

Business Name:

Primary Contact:

Position in Company:

Address:

City/Town:

State/Province:

ZIP/Postal Code:

Country:

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2. Phone Number

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3. E-mail Address

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4. Years in Business

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5. Number of Employees

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6. Total sales revenue for 2011 (please do not use a dollar sign; this is a numerical text box).

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7. Projected revenue for 2012 (please do not use a dollar sign; this is a numerical text box).

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8. Which title most accurately describes your role?

Business Owner - Sole Proprietor

Business Owner - with Partner(s)

Employee - Sales

Employee - Service

Employee - Admin

Independent Consultant