First and Last Name
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City
Phone Number
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Email
Do you have interest in topics and tools needed to be a successful Entrepreneur?
Yes No
If there were only ONE topic that you would be eager to know about in regards to business, what would it be?
What would you say is the hardest thing about having a business/being an entrepreneur?
Speaking of business, who/what has been your biggest influence? Why?
How much would you be willing to pay to hear an expert speak about your topic of interest?
How much time do you feel would be needed to cover your topic(s) of interest?
0.5 - 1 hour 1 - 2 hours 2 - 3 hours 3 - 4 hours
Which day and time would be most convenient for you to attend a seminar?
