Leaders Network Application Form

Already a WIC member? Click here to autofill this form
Thank you for your interest in the WIC Leaders Network! If what you have learned about the WIC Leaders Network interests you, the next step is to complete this application. We will contact you after we have reviewed your application to let you know where we stand in expanding the Leaders Network groups and in matching your candidacy to the available openings.

Participation Requirements

To be eligible for participation in the WIC Leaders Network, you will ideally meet at least seven of the business model/operation requirements criteria below, including the first three that are starred as required. Kindly supply the information below and check the boxes that apply to your candidacy – providing a little more detail where you feel it would help.

* required information
  
Please provide the information below
Title:*
First Name:*
Last Name:*
Company Name:*
Job Title:
Company Website (must include http://):
Email:*
City:*
State:*
Business Phone:*
Cell Phone:
Fax:
Please describe your business:*
Baseline Reveue Requirement:* Solo Pratictioner: $250K/year
Organization: $500K/year
Please provide your bio and address your expertise with complex business models and senior executive level business experience.:*
Business Model/Operations Reqmts (first 3 are required; check all that apply to confirm where you meet requirements):* *Work with a number of projects/clients (as opposed to reliance on 1-3)*
*P&L responsibility (Business owner or General Management)*
*10+ years of business experience (prefer minimum 5 years consulting)*
Complex business model for 2+ years (operate on more than hourly contract)
Sales interface at client C-Level
High-growth/strong revenue goals
High-productivity goals
If you would care to expand on any of these items, please feel free in this section:
How did you hear about us?:*
By submitting this application, I affirm that my answers above are an accurate depiction of my business. I agree to abide by the guidelines covered in the WIC Leaders Network Overview, including participation and confidentiality.

I understand that this is the first step in submitting my candidacy to a Leaders Network group and my ultimate participation will be determined by a combination of available space within a group, the non-competitive nature of my business to existing group members, and finally to the group members acceptance. Failure to comply with these guidelines will nullify my membership.
        

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