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Visionary Leadership Mastermind Application

1.What is your name?(Required.)
2.What is your current professional work, if any (please provide your title & organization and/or brief description, as applicable)(Required.)
3.How and when can we most easily reach you? Please provide your email address, phone number, time zone, and the best time to reach you between 12-6pm Pacific.(Required.)
4.What are you seeking right now that makes it important for you to participate in the Visionary Leadership Mastermind?(Required.)
5.What would you like to see shift and change in yourself and/or your leadership in order to move towards this future possibility? Why is this important and why now? (Required.)
6.What skills and competencies do you need to develop in order to make this possibility real?(Required.)
7.How committed are you to doing what it will take to making this program a huge success for you? Please explain.(Required.)
8.Please describe your professional experience, your current sense of your work purpose/mission, and what will be most important to take it to the next level.(Required.)
9.What programs and/or practices have been most transformational for you, and how have you grown from them?(Required.)
10.What support structures do you have in your life to ensure that you can successfully complete this program?(Required.)
11.What do you envision for yourself at the end of this program?(Required.)
12.Are you available to travel to Nevada City, California for the Mastermind Intensive, May 1-4?(Required.)
13.Are you able to pay the full costs of this program using either the single or 3-pay model?
14.Would you like to schedule an interview before registering in the program?(Required.)
After clicking the Done button below, you will be directed to place your deposit. If your application is not accepted, your deposit will be fully refunded.

The next step will involve an interview with either Stephen Dinan or Devaa Haley Mitchell. At this time you can ask any questions about the program. If within 3 days after the interview either you or the faculty decide that the program is not a good fit for you, your deposit will be fully refunded.
15.Do you have any questions that you would like to ask us about the program? If so, please list them here: