First & Last Name
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Employer
Phone Number
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Email
Which Mastermind Group are you interested in joining? Aspiring Entrepreneurs Level Up
When did you join SVYP?
month January February March April May June July August September October November December year 2007 2008 2009 Not an SVYP member
Have you ever participated in a Mastermind Group?
Yes No
What is your current position / title?
Tell us a story that exemplifies your entrepreneurial spirit.
What is the next desired level in your career?
What is the product or service that you would like to offer?
Where would you like your career to be in five years from now?
Who do you want to be as a business owner?
Tell us about a time when you felt really alive. What impact were you having?
How will other members benefit by having you in the group?
Where do you want your business to be 5 years from now?
How long have you been thinking about starting your own business?
less than one month 1 - 6 months 1 year more than one year
How many employees do you manage?
none 1 - 20 employees 20 - 50 employees more than 50 employees
Which day and time would be most convenient for you to participate in Masterminds?
