MAC Forum Application - Intentional AchievementsIntentional Achievements |

First Name*

Last Name*

Company Name*

Address*

City*

State*

Zip Code*

Business Phone #

Cell Phone #*

E-mail*

Company Website

Current Business Position*

# of Years*

2017 Business Goals*

2017 Personal Goals*

Biggest Challenges*

Current Actions*

What is your motivation level to change and grow? 10=highest*

Explain*

Hoping to get*

Planning to give*

Measurement*

Strengths*

Areas for Improvement*

What else?*

I am willing to commit to the following accountability requirements:

Regular, on time, attendance*

Yes

Stay focused and engaged*

Yes

Do the work inside and outside each meeting*

Yes

Be held accountable*

Yes

Not accept less than my best*

Yes

Open to coaching*

Yes

I understand and acknowledge that submitting this application is no guarantee of acceptance into an Intentional MAC Forum.

Understand and Acknowledge*

Yes

Thank you very much for your interest in the Intentional Mastermind and Coaching Forums. We will review your application and get back to you shortly.