Member Information - P1 Strategies

Elite Leadership Peer Group - Member Information

Please complete this form to help me understand your background, goals and interests.

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Comments

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Basic Information

Name*

First Last

Company/Organization*

Title/Role

Preferred Email*

Preferred Phone*

Industry/Sector

Company Size (# of employees)

Years in Current Role

Goals & Objectives

1. What are the most important outcomes you'd want from membership?

2. What's one skill, habit or leadership muscle you most want to sharpen?

3. What's one blind spot, challenge or barrier you want to confront?

4. What would make this group a poor use of your time?

5. What are 2-3 professional goals over the next 6-12 months?

6. What are 2-3 personal goals over the next 6-12 months?

Background & Interests

What is your hometown?

Where do you live now?

Birthday (Month/Day)

Education/Trade/Early Career

Partner's Name (if applicable)

Children - Names & Ages (if applicable)

How do you recharge outside of work?

Best Time to Contact

Preferred Communication Method

Emergency Contact Name (and relationship)

Emergency Contact Phone

Food & Beverage Preferences

(Include preferred brands if applicable)

Favorite Food

Favorite Date Night Location

Favorite Coffee Shop

Favorite Place to Grab a Drink

Non-Alcoholic

Beer

Wine

Spirit

Snack Preference

Salty

Sweet

Both

Dietary Restrictions/Allergies

Billing Information

Company Name (if applicable)

Billing Contact Name

Billing Phone

Billing Email

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code