Name Who Grants You Access Who Grants You Access FIRST NAME * LAST NAME * EMAIL ADDRESS * DAYTIME PHONE COMPANY NAME WEBSITE MAILING STREET ADDRESS CITY STATE / PROVINCE POSTAL / ZIP CODE OWNER/CEO? INDUSTRY HOW MANY EMPLOYEES HOW MANY INDEPENDENT CONTRACTORS WHAT PROBLEM DO YOUR SOLVE FOR YOU CUSTOMERS WHERE ARE YOU RIGHT NOW IN YOUR BUSINESS? ANNUAL GROSS REVENUE? WHAT WOULD YOU SAY YOUR BIGGEST PAIN OR OBSTACLE LIST UP TO 5 CHALLENGES YOU WOULD LIKE HELP WITH (PERSONAL OR BUSINESS): HAVE YOU PARTICIPATED IN A MASTERMIND GROUP BEFORE? Yes No IF YES, WHO WITH? AND, WHAT DID YOU LIKE/DISLIKE ABOUT THAT GROUP: HOW WOULD YOU RATE YOURSELF AS AN EFFECTIVE MARKETER (1-5)? (1 - TERRIBLE, 5 - ROCKSTAR) 1 2 3 4 5 IF YOU ASKED PERSONAL FRIENDS AND COLLEAGUES WHAT THEY THOUGHT YOU WERE BEST AT (WHAT'S YOUR MAGIC?), WHAT WOULD THEY SAY? PLEASE LIST 3 BENEFITS YOU COULD CONTRIBUTE TO AN EXCLUSIVE GROUP LIKE THIS: I UNDERSTAND SYNDICATE X IS AN ELITE AND HIGH PROFILE GROUP WHICH INCLUDES INDUSTRY TRANSFORMERS FROM ALL OVER THE WORLD THAT DIVULGE INDUSTRY SECRETS, REVEAL INVALUABLE MARKETING AND BUSINESS STRATEGIES & ADVICE, AND OPENLY SHARE UNIQUE INTELLECTUAL CAPITAL; THEREFORE I AM WILLING TO SIGN A CONFIDENTIALITY AGREEMENT TO PROTECT MEMBERS OF THE GROUP, AS WELL AS MYSELF IF I AM ACCEPTED. AGREE DISAGREE I UNDERSTAND AND MEET ALL THE FOLLOWING REQUIREMENTS TO BE CONSIDERED FOR SYNDICATE X: MY ORGANIZATION BRINGS IN A MINIMUM OF $1,000,000 ANNUAL REVENUE AND/OR MY PERSONAL NET INCOME IS CURRENTLY AT LEAST $500,000 PER YEAR. INVESTING FOR THE DEVELOPMENT AND IMPROVEMENT OF MYSELF AND MY BUSINESS THROUGH SYNDICATE X IS NOT A BURDEN. AGREE DISAGREE
