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Member Info
Circle Of Success Membership
Bi-Monthly Saturday Meetings : 10am - 4:30pm
2020 Dates : 01.11.20 , 03.14.20 , 05.16.20
07.18.20 , 09.19.20 , Nov TBD
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Number of Memberships
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1
2
3
Name
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First
Last
Name #2
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First
Last
Email
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Name #3
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First
Last
Cell Phone (Text Message reminders)
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Questionnaire
For multiple memberships specify each member.
1. Self development events you have attended.
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2. Favorite speakers, authors, coaches etc.
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3. What material are you currently working on? What events are you planning on attending this year?
4. What are some changes you have made in your life?
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5. What are some changes you are currently working on?
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6. Do you have a morning ritual?
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Yes
No
Briefly describe your morning ritual.
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7. What are you looking for in a peer group? How we can add value to your life?
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8. How can you add value to the group?
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9. We believe in being a force for good. Are you interested in charity work?
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Yes
No
10. Topics of interest (select all that apply)
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Mindset
NLP
Business / Marketing
Confidence
Career
Motivation
Communication (Listening, Public Speaking, Presenting)
Self Understanding
Leadership
Optimism / Positivity / Happiness
Organization / Efficiency
Families / Parenting / Relationships
Purpose / Passion / Vision
Assertiveness / Attitude
11. Any additional topics that would interest you.
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Phone
Submit