Your Name

Your Website Address

Email Address

Phone Number

Share with me please...who you are and what you do. Why are you passionate about your work?

What are your TOP 5 strengths?

What are the top goals you hope to achieve in the next 12 to 18 months?

How do you think working with Diana in the CEO Mastermind will help you to achieve those goals?

What do you feel you need the most help with right now? Check all that apply. What do you feel you need the most help with right now? Check all that apply. Refining my target market Managing growth and creating systems Selecting which ideas & opportunities to focus on Creating a marketing strategy & implementation plan Staying in consistent & inspired action Confidently charging what you are worth Productivity & time management Creating, launching or optimizing my website Starting or growing my community and list Creating irresistible programs, services and offerings Turning your expertise into virtual programs Launching your program or service Clarity on business goals and direction Speaking to increase my business visibility

What is the size of your Email List?

Your Facebook Page

Your LinkedIn Profile Address

I understand that by filing out this application, I am requesting to be considered for one of the 6 Mastermind spots. At this point in time, I understand I am showing interest only in the program and am under no obligation to join or make payment. Before acceptance into this program, I may be requested to have a 15 minute interview with Diana to ensure a 100% win-win and perfect fit. I understand that if I am accepted into the program, after reviewing and submitting my payment contract (supplied after this document is received and approved), I am committed to the program for its duration. I understand my role and the role of my mentor in this program. I will ask questions and clarify anything I don’t understand. I am committed to taking action and doing everything I need to do to get 100% from the program. I understand that by filing out this application, I am requesting to be considered for one of the 6 Mastermind spots. At this point in time, I understand I am showing interest only in the program and am under no obligation to join or make payment. Before acceptance into this program, I may be requested to have a 15 minute interview with Diana to ensure a 100% win-win and perfect fit. I understand that if I am accepted into the program, after reviewing and submitting my payment contract (supplied after this document is received and approved), I am committed to the program for its duration. I understand my role and the role of my mentor in this program. I will ask questions and clarify anything I don’t understand. I am committed to taking action and doing everything I need to do to get 100% from the program. I agree to the terms above and submit my application for review