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Jill's Accountability Circle Application

Where Decision-Makers Connect, Confide, and Collaborate

Join other business leaders in a facilitated, confidential, peer-peer environment.

To be considered, you must:
• Lead as an executive
• Value meaningful connections with peers
• Respect confidentiality and non solicitation rules
• Commit to consistent attendance

Complete this form to join our invitation list. Jill will personally reach out to qualified applicants.

By completing this form, you agree to our CODE OF CONDUCT.
1.First and Last name
2.Company Name
3.Industry or NAISC Code
4.Cell phone number
5.Email
6.Title
7.Number of employees
8.Revenue
9.Groups I am interested in - you may choose more than one (and then we'll discuss best fit). $4,250 per year unless noted:
10.Anything else Jill should know that doesn't fit in the box below? Send her an email: jill@meetatjills.com