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Name
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First
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Email
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Phone
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Which best describes you?
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Small Business Owner or Entrepreneur
Executive or Manager
Employee
Your Website (if you don't have one please type No Site)
How were you referred to us?
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Select One
A current member referred me
LinkedIn
Facebook
Google Search
Other
Who referred you?
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If other, please elaborate.
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Current Monthly Revenue for the business you would like to discuss.
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Less than $1000 per month
$1000 to $5000 per month
$5000 to $10,000 per month
$10,000 to $20,000 per month
$20,000 to $50,000 per month
$50,000 per month or more
Your Current Annual Income
*
Under $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 - $250,000
Over $250,000
What is your target annual income?
*
What is your target monthly revenue for this business?
*
What is your biggest obstacle to hitting your monthly revenue?
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What is your biggest obstacle to hitting your annual income?
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Are you currently going through a career transition?
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No
Yes
Not yet, may may be soon
Please describe the issues or challenges you experience in your current career, occupation, or marketplace offer.
*
HOW have you been trying to meet your aims?
*
How do you seek to grow through Influential U?
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What are your goals and what do you want to accomplish?
How willing and able are you to invest in your professional growth right now?
*
I have the financial resources to invest in my professional growth right now.
I have access to the financial resources to invest in my professional growth right now.
I don't have financial resources to invest in my professional growth right now, but hope to in the future
LinkedIn profile
Country
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Afghanistan
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Antarctica
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Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
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Bouvet Island
Brazil
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Canada
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Chile
China
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Colombia
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Congo, Republic of the
Cook Islands
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Isle of Man
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Libya
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Lithuania
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Niger
Nigeria
Niue
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Norway
Oman
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Panama
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Paraguay
Peru
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Poland
Portugal
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Qatar
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Russia
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Saint Barthélemy
Saint Helena
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Samoa
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Sint Maarten
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Slovenia
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South Georgia
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Sudan
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Sweden
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Syria
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Tajikistan
Tanzania
Thailand
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Tonga
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Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
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Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
If accepted, how soon can you get started?
*
Immediately
1-2 months from now
3-6 months from now
Our programs are for ambitious professionals, what about you demonstrates your ambition?
Which associate are you currently working with?
*
Please make your selection
Drew Knowles
John Patterson
Josh Damigo
Kirkland Tibbels
Marne Power
Tim Nicklas
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