Top Dog Registration_Pre

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Thank you for your interest in the Top Dog group. We're excited about the opportunity to pull top leaders together from non-competing fields to help position one another for success through the sharing of ideas and brainstorming. (Trust me, we gain as much from this interactive group as do the participants!)

This group is for Top Dogs on the same level who are committed to growing professionally and relationally. The cost is to be announced.

To develop the best mix for the group and to make certain we don't have competing interests in it, we're asking interested persons to pre-register by answering the following information. Once your application has been accepted, we'll be in touch with payment options and class times. (If you have any questions while filling out this application, please call Doris @573 819-0706.)

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* 1. Contact Information (Name, company, position, and email/phone obligatory. Mailing address optional.)

Name: *

Company: *

Address:

City/Town:

State:

ZIP:

Position within Company *

Email Address: *

Phone Number: *

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* 2. In what way has your organization (or you personally within your organization) exhibited innovation or out of the box thinking?

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* 3. What is/are your organization's main industry/industries?

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* 4. How many of the following do you "manage" on a regular basis, whether as direct reports or through other managers/supervisors?

	0	1-5	6 - 15	16 - 50	51 - 100	101 and greater	n/a
Employees	Employees 0	Employees 1-5	Employees 6 - 15	Employees 16 - 50	Employees 51 - 100	Employees 101 and greater	Employees n/a
Volunteers	Volunteers 0	Volunteers 1-5	Volunteers 6 - 15	Volunteers 16 - 50	Volunteers 51 - 100	Volunteers 101 and greater	Volunteers n/a
Contractors	Contractors 0	Contractors 1-5	Contractors 6 - 15	Contractors 16 - 50	Contractors 51 - 100	Contractors 101 and greater	Contractors n/a
Other	Other 0	Other 1-5	Other 6 - 15	Other 16 - 50	Other 51 - 100	Other 101 and greater	Other n/a

Other

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* 5. While the cost for this group yet is still low, you may eligible for discounts depending upon answers to the following questions:

	Yes	No
Are you a regular client of Executive Advantage, LLC?	Are you a regular client of Executive Advantage, LLC? Yes	Are you a regular client of Executive Advantage, LLC? No
Do you have a business affiliation with Services for Independent Living?	Do you have a business affiliation with Services for Independent Living? Yes	Do you have a business affiliation with Services for Independent Living? No

Other (please specify)

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* 6. Mark 3 of the below where you excel most as an organization or Top Dog?

Leadership

Vision setting

Managing chaos

Branding

Technology

Setting up systems

Prospecting/Selling/Business Development

Team Building

Managing Change

Other (please specify)

Top Dog Registration_Pre

1. Default Section

Question Title

* 1. Contact Information (Name, company, position, and email/phone obligatory. Mailing address optional.)

Question Title

* 2. In what way has your organization (or you personally within your organization) exhibited innovation or out of the box thinking?

Question Title

* 3. What is/are your organization's main industry/industries?

Question Title

* 4. How many of the following do you "manage" on a regular basis, whether as direct reports or through other managers/supervisors?

Question Title

* 5. While the cost for this group yet is still low, you may eligible for discounts depending upon answers to the following questions:

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* 6. Mark 3 of the below where you excel most as an organization or Top Dog?

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* 7. What are your expectations from this Top Dog group?

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* 8. Who else would you recommend our inviting to this or other Top Dog groups?