*1.What is your name?(Required.)

*2.What is your email address?(Required.)

3.How did you hear about me?

4.Tell me about your business.

5.What was the gross revenue of your business in the past year? (Last 12 months.)

$0 - $100,000

$101,000 - $250,000

$251,000 - $500,000

$501,000 - $1,000,000

$1,001,000 - $5,000,000

$5,001,000+

6.If you had a magic wand, where would you like your business to be 6 to 12 months from now? The more details the better.

7.What do you need the most help with right now?

8.As you may know, working with A-Players is very important to me. Please tell me why you're an A-Player and why you believe you'd be a good fit for this group.

9.Is there anything else you'd like me to know about as I review your application? If yes, please tell me about it here.