Interest Form

This program is designed for women in executive positions (VP or C-suite). This interest form will be use to ensure fit and for circle matching. We will get back to you mid-Janaury with an update.

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* 1. Name

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* 2. Job Title

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* 3. Company

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* 4. Email Address (Note that your email addresses will be shared to the members within your circle.)

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* 5. How many years have you been in executive roles (VP or C-suite)?

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* 6. What would you hope to walk away from this program with?

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* 7. What are some topics you would like to discuss?

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* 8. How did you hear about the program?

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