* 1. Have you ever participated in a Mastermind Group before?

* 2. How many times per month would you like to meet?

* 3. Would you be interested in meeting via tele-conference or in person?

* 4. What industry are you in?

* 5. For an in person meeting which area(s) do you prefer?

* 6. What time(s) would you prefer to meet?

* 7. What do you hope to get out of participating in this Mastermind program?

* 8. Please provide your contact information. Name, Company Name, Email and Phone Number are required.

* 9. Please list any comments or questions here.