First Name

Last Name

Phone *

Email *

Company

Current Title

How many years have you operated at the senior/executive level?

Your current role is best described as:

What are your primary areas of responsibility?

Why are you exploring an executive mastermind right now?

What’s the most important shift you want to make in the next 12 months—personally or professionally?

What do you value most in a peer room at your level?

Which best describes what you’re craving from community at this stage?

Are you willing to commit at least 2–4 hours/month to your leadership growth and mastermind experience?

What would make this mastermind a clear “yes” for you?

If accepted, are you ready to join our January 2026 cohort??

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