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Larry Broughton's Elite Private Mastermind Application

Please continue filling in the information below, scrolling down, so that we can know more about you and your business - it should only take a few minutes and will help us determine if you will qualify.

Note: These are paid programs.

Name*
First Last
Email*

Mobile Phone*
Company Name*
Website Address

For Which Program are you applying?*
Please choose one

Virtual Mastermind

In Person Mastermind (one 3-day session)

In Person Mastermind (year long program)

VIP Mastermind Package (year long program)

CEO Mastermind Platinum Package (year long program)
IMPORTANT: Please be honest and authentic with your answers. It’s the only way we can help you get real results!
All information provided on this form is strictly confidential.
Are You Coachable?*

Yes

No

Maybe
Are you willing and able to invest in your personal and professional development?*

Yes

No

Maybe
Have you ever worked with a business mentor/coach or mastermind group before?*

Yes

No

Maybe
What Contributions can you make to the group?*
Describe Your Business or Concept*
Please describe your business as it is right now, or the concept you are considering. Include any services or products that you offer or want to offer, as well as the average price point for those offerings. Describe your role in the business. (250 words or less)
Next 12 month Projected Gross Revenue*
Please check your approximate projected gross business revenue. (Please note this is completely CONFIDENTIAL. Your application will not be considered without this information.)

Less than $1Million

$1Million - $5Million

$5Million - $10Million

$10Million - $25Million

$25Million - $50Million

$50Million +
I would describe the stage of my entrepreneurial and leadership journey I’m in as:*
Newbie = I’ve just started in business. I’m learning a lot and building from scratch.
Growth = I know what I’m doing. These next 12 months are about growing my revenue and building my team/systems.
Leverage = My business and experience is solid. Now I’m ready for more balance, freedom and money.
Preparing to exit = I need a succession plan/exit strategy that includes passive income.

Newbie

Growth

Leverage

Preparing to exit
My Business or Venture's financial situation*
Early stage startup and fundraising
Still struggling to make a profit = I'm not generating cash flow at the level I know is possible.
Doing okay = My revenue is up and down. I would like more consistency and to increase profits.
Successful and thriving = I’m meeting my financial needs, but I’m also ready for a quantum leap.

Early stage startup and fundraising

Still struggling to make a profit

Doing okay

Successful and thriving
When I make decisions, I*
Choose the best description for how you make decisions.

Act impulsively or rashly

Move quickly and decisively.

Think about it, analyze the pros/cons and then decide.

Collect as much information as possible and analyze for months before deciding.
What are the three most important goals you want to accomplish, personally or professionally, in the next 12 to 18 months?*
Please select the + button on the right of the entry to add more rows. Please enter 3 goals.

Please elaborate on the one or two biggest challenges or areas you are struggling with the most.*
If you are a military veteran, please share a bit about your military background:
Please include Service Branch, Service Years, Rank on separation/retirement, and Relevant skills/takeaways from your military service.
What else would you like us to know when considering you for this program?
Name
This field is for validation purposes and should be left unchanged.

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