Program Intake Form

If you are interested in joining a leadership circle, please take a few minutes to fill this survey out. This will allow me to better understand your needs for the program and pair you with like-minded women. Thanks!

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* 1. What is your full name?

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* 2. What is your best email address to communicate with you?

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* 3. What is your current employment?

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* 4. Are you a leader within your organization?

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* 5. What level of leader would you describe yourself as?

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* 6. Which timezone/country do you work in?

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* 7. Which topics are most important to you from this list?

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* 8. What days of the week work better for you to join consistently every month?

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* 9. What time of day works best with your schedule to meet?

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* 10. Why do you want to join the CLIMB the Mountain program this year? Do you have specific goals you are working towards?

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