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1. Contact Info (Required.)

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2. How long have you been in your position?

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3. Number of employees in organization

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4. Why do you want to be a part of a Mastermind group? What are the top three goals you want to achieve by being a member?

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5. How did you learn about this opportunity?

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6. What topics would you like our group to address over the course of the next six months? (rank each topic in order from most to least interest)

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