Captains Council

Full Name

Phone *

Follow Up info

Welcome to
The Captains Council

See if you qualify to join our peer-advisory council for vetted business owners and CEOs by answering a few questions. Takes 7 minutes

The Basics

Thanks for your interest in being a member of the Captains Council.

First Name *

Last Name *

If other than English, say: Would you prefer a group in your Primary language? Or can you participate in English?

City

What City, State do you live in?

What City, State do you live in? *

State *

Bio

Email *

Phone *

Linkedin URL: https://www.linkedin.com/in/yourname *

Company Name

What is the Name of your Company?

Business Name *

Web URL goes here *

Problem

What problem does your company solve?

What pain do you solve? *

Who do you help? *

Tech Savvy?

What's your favorite community platform? *

In regards to your previous exit...

What was the name of your previous company?

What was your role?

What was the exit valuation?

Time Allocation

Are you willing to dedicate a distraction free 3 hour block per month for your private council group? *

Yes

No

Maybe

Level of Commitment

Are you willing to commit yourself to be challenged by your peers and offer honest feedback to accelerate the growth of both YOUR business as well as the growth of your peers? *

Yes

No

Maybe

Privacy and Confidentiality

Real growth can only happen when Trust can be felt from the members of your council. Confidentiality is taken Extremely seriously. Are you willing to sign a privacy agreement if accepted? *

Yes

No

Experience

Have you ever worked with an executive coach, or been part of a paid Executive group before?

Yes

No

If Yes: Which organization was it?

Was there something that could have made it better?

Intention

Please share with us what you hope to get out of your membership in the Captains Council? *

What was going on in your life today that brought you to this application? *

If others please specify on the box below:

Leaving anything out?

Is there anything else we should consider when deciding if you are a good fit? (optional)

Recommendations

Who are three other founders/ operators that you admire and would love to have in your Council?

1.
2.
3.

Finish

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