MasterMinds Potential New Member Survey

MasterMinds Application

Thank you for taking the time to access the Master Minds online application. This is the first step to learning more about Master Minds. The second step is that a Master Minds committee member will call you to answer any questions and explain the next steps as you consider becoming a group member.

This information is confidential.

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1. Please provide us with the following information.

Name:

Company:

Address:

City/Town:

State:

ZIP/Postal Code:

Email Address:

Phone Number:

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2. Please add the following information about you and your role:

Company Position Title

Major Role/Responsibilities

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3. Please select the industry/business area that best describes your business. Select "Other" to give more exact information about your business.

Accounting

Legal

Financial Services

Health care - Traditional, Complementary

Consultant

Manufacturer

Retail

Technology

Web Design

Marketing/PR/Social Media

Human Resources/Employment Services

Insurance- medical, life, benefits

Other (please detail)

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4. Please share some basic information about your business which will help us to provide you with the best MasterMinds peer.

Number of Employees

Length of Time in Business

Business Type

Business Stage

Business Ownership

Annual Revenue/Income

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5. Have you participated in a Master Minds program before, either with the Greater Lehigh Valley Chamber or another group:

Yes

Other (please specify)

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6. Please rank the attributes of the group that are most important to you with 1 being your highest priority.

	1	2	3	4	5
# of Employees	# of Employees 1	# of Employees 2	# of Employees 3	# of Employees 4	# of Employees 5
Annual Revenue/Income	Annual Revenue/Income 1	Annual Revenue/Income 2	Annual Revenue/Income 3	Annual Revenue/Income 4	Annual Revenue/Income 5
Length of time in Business	Length of time in Business 1	Length of time in Business 2	Length of time in Business 3	Length of time in Business 4	Length of time in Business 5
Ownership	Ownership 1	Ownership 2	Ownership 3	Ownership 4	Ownership 5
Business stage	Business stage 1	Business stage 2	Business stage 3	Business stage 4	Business stage 5

Other (please specify)

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7. Another way to help form MasterMinds groups is to understand preferences in meeting times and locations. Although some groups will tend to move to each others business locations, generally the time remains consistent. Please note your preference for each. My preference is:

Meeting Time:

Geographic Area:

Other (please specify):

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8. If you were forming a MasterMinds group, what additional information would you like to know about your peer group? Is there a business owner that you would like to paired with?

The next step is a telephone interview. One of the members of the Small Business Council's MasterMinds Committee will be following up with you to answer any questions and tell you about the process from this point on.

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