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* 1. Contact information

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* 2. What is your title in your organization?

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* 3. Please select any areas of interest.

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* 4. What is your greatest frustration or challenge in your leadership position?

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* 5. What are you hoping to get out of a mastermind?

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* 6. A mastermind is a round-robin facilitated session in which professionals support and encourage each other. Colleagues challenge assumptions and ask provocative questions with the purpose of helping you level up.

Are you willing to actively participate in these sessions and bring an open mind? Are you able to commit to weekly sessions so that colleagues get the benefit of your input and vice versa?

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* 7. Great, thank you! We will be in touch to discuss the mastermind in more detail.

If you have any other comments, please feel free to leave them here.

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