CEO Circle Application A circle that’s in your corner—championing your growth, goals, and greatness. ← BackThank you for your response. ✨ Name Email Address(required) City, State LinkedIn or Website URL Current Role/Title Industry/Sector Years of Leadership or Executive Experience Select one option 1-3 4-6 7- 10 11+ Do you currently have a team? How did you find out about the CEO Circle? Why are you interested in the CEO Circle? What are 2-3 personal and/or professional goals you want to accomplish within the next year? Which CEO Circle Themes resonate with you the most in terms of skilling that you want or need? The Confident CEO The Creative CEO The Focused CEO The Healthy CEO The Productive CEO The Problem-Solving CEO The Resilient CEO The Connected CEO Can you engage fully in the 9 month program? You’re looking at a 2-3 hour virtual live commitment per month and 1-2 hours outside of our time of your own development and application. What day/time can you meet? 2nd Tuesday at 7:00 AM CST or 2nd Friday at 1:00 PM CST. Suggest alternates if none of these are best. Are you willing to attend live monthly sessions (60 – 90 minutes) and a monthly 1-on-1 coaching call? Select one option Yes No It depends on my schedule Which payment do you prefer? Pay in Full – $3,997 Two Payments – $2, 237 each (1st payment due by August 25, 2025 and 2nd payment due by January 25, 2026) Month Payments – $497/month (1st payment due August 25, 2025. Remaining payments due the 25th of each month) Preferred way to hear from us Select one option Email Phone call Text message WhatsApp Phone Number Is there anything else you want us to know about you? ✨ That’s it! Send it over and we’ll take care of the rest. You’ll back from someone within 3-5 business days if not sooner. ← BackSubmitting form Next →Submitting form SubmitSubmitting form Δ
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