NextGEN Application

Name

First Name

Last Name

Company Name

Company Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Company Website

http://

Phone

(###)

###

####

Why do you want to be a part of our local coaching + mastermind group?

What sets you apart from other companies who do what you do?

What is the magic you bring to your business?

What is the magic you bring to your industry?

What are your goals in joining this group? What do you want to take away?

What challenges is your company currently facing?

What is the vision for your business in the next three to five years?

How many locations do you have?

How many employees do you have?

Is there anything else you'd like us to know as we consider you for a spot in our group?