CONFIDENTIAL - MASTERMIND APPLICATION
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    Please rank each of the following marketing-oriented items according to the difficult or challenge 
    they currently represent to you; rank EACH ONE on a 1-5 scale, 1=Insignificant, to 5=Very 
    Significant. ALSO, number the ten most important items to you 1-10, 10=most important.
      
      Ranking
    Please rank each of the following business and financial-oriented items according to the difficulty 
    or challenge they currently represent to you; rank EACH ONE on a 1-5 scale, 1=Insignificant, to 
    5=Very Significant. ALSO, number the ten most important items to you 1-10, 10=most important. 
    Do you regularly or frequently use:

    How many marketing strategies or systems do you have in place that consistently generate new 
    business for you? 
    How many marketing strategies or systems do you have in place that consistently stimulate 
    repeat business, lock in continuing or renewable income and/or stimulate referrals?
    Describe 3, 4, or 5 major goals you are working on: 
    Describe 3 major sources of stress, frustration or unhappiness that interfere with your 
    productivity and rob you of peace of mind:
    Your Schedule
YES, Michelle! I’m ready to jump in with both feet to propel my business to the next level in 
2013. I’m ready to accelerate my success through your supercharged marketing and moneymaking Mastermind experience. I’m ready to take advantage of: 
  • Facilitated learning and applications of the MACs Mastermind strategies; 
  • Friendly accountability and encouragement; 
  • Creative thinking multiplied through fellow members; 
  • Peer advisory “sounding boards”; 
  • Opportunities for cooperative alliances with fellow members.
 _____ Monthly automatic billing for Mastermind Silver Program: I would like to have my $347 monthly 
dues automatically billed to the credit card listed below ($447 if application is received after 4/30/2013). 

_____ Full year payment for Mastermind Silver Program: I would like to pay for 10 months in advance 
and receive two additional full months of Mastermind group membership free for $3,470 (credit card). ($4,470 if application is received after 4/30/2013). 

_____ Monthly automatic billing for Mastermind Gold Program: I would like to have my $597 monthly 
dues automatically billed to the credit card listed below. ($647 if application is received after 4/30/2013). 

_____ Full year payment for Mastermind Gold Program: I would like to pay for 10 months in advance 
and receive two additional full months of Mastermind group membership free ($5970 – credit card). ($6470 if application is received after 4/30/2013). 

I affirm that the name and personal information provided on this form is true and correct.
Thank you for the opportunity to help you create awesome success in 2013!