PUSH Alliance
What is PUSH Alliance?
Member Success
Leadership
Pricing
Get Inspired
PUSH Mondays
Achievements
Mindset Awareness
Nutrition
Personal Finance
PUSH Fitness
Start Now
What is PUSH Alliance?
Member Success
Leadership
Pricing
Get Inspired
PUSH Mondays
Achievements
Mindset Awareness
Nutrition
Personal Finance
PUSH Fitness
Start Now
Membership Application
Please enter the requested information and answer the questions below as honest and comprehensively as possible. Once you advance to the next page, you can not return to the previous one.
Please enable JavaScript in your browser to complete this form.
1
Administrative Information
2
Team Dynamics
3
Self-Awareness
4
Improvement Areas
Name
*
First
Last
Email
*
Email
Confirm Email
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Date of Birth
*
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Do you have children?
*
Yes
No
Occupation
*
Job/Business Title
*
Provide a brief description of your job or business duties
*
Next
Team Awareness
PUSH is about the community and us each doing our part individually (working to be better and more productive) to make the cohesive unit stronger overall. We all attain more together than we can being apart.
Are you willing to make the necessary adjustments to your personal life to meet with your designated PUSH team once a week (currently Sunday or Monday evenings) via Zoom?
*
Yes
No
Are you willing to assist, support, encourage, and share information at will (in any way you can), with other PUSH community members in an effort to increase the overall community dynamics?
*
Yes
No
What does it mean to you to be a team player?
*
What motivates you?
*
Items Knowledgeable About
Is there anything that you do or have an interest in that you would consider yourself relatively knowledgeable about and could potentially help other with? Please document item(s) below. Note: If none enter "N/A".
1st Item (Knowledgeable About)
*
2nd Item (Knowledgeable About)
*
3rd Item (Knowledgeable About)
*
Next
My Hobbies
Please list your 3 favorite hobbies or pastimes?
Hobby 1
*
Hobby 2
*
Hobby 3
*
Items Your Consistent With
Identify three (3) things which you find yourself to be most consistent with doing and your reason for each. Note: Some examples are spending time with family/friends, exercising, reading, leisure time, working on your business, financial planning, career related items after hours (certifications, degrees), etc.
Current Consistent Item 1
*
Current Consistent Item 2
*
Current Consistent Item 3
*
Items Your Procrastinating On
Please identify three (3) tasks which have been on your "to-do" list for 3 months or longer which you've procrastinated on doing. Note: Some examples are organize/rearrange your closet, exercising regularly, home improvement work, spending intentional time with your kid(s), career/business advancement items, etc.
Procrastination Item 1
*
Procrastination Item 2
*
Procrastination Item 3
*
Things You Want to be Doing
Please Identify three (3) things which you currently are not doing, that you would like to be doing and the reason why you've been failing to do each. Note: Note: Some examples are spending time with family/friends, exercising, reading, leisure time, working on your business, financial planning, career related items after hours (certifications, degrees), etc.
Desired Consistent Item 1
*
Desired Consistent Item 2
*
Desired Consistent Item 3
*
Next
Personal and Professional Improvement
What aspects of your personal and/or professional life are you most interested in improving currently? Please identify in order of importance to you, your top 5 focus areas.
1st Priority Focus
*
What is your most important priority item?
Personal Growth/Development
Business Creation/Development
Career Development
Expanding My Network
Faith
Finances
Fun (Leisure Time)
Helping Others
Professional Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
2nd Priority Focus
*
What is your 2nd most important priority item?
Personal Growth/Development
Business Creation/Development
Career Development
Expanding My Network
Faith
Finances
Fun (Leisure Time)
Helping Others
Professional Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
3rd Priority Focus
*
What is your 3rd most important priority item?
Personal Growth/Development
Business Creation/Development
Career Development
Expanding My Network
Faith
Finances
Fun (Leisure Time)
Helping Others
Professional Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
4th Priority Focus
*
What is your 4th most important priority item?
Personal Growth/Development
Business Creation/Development
Career Development
Expanding My Network
Faith
Finances
Fun (Leisure Time)
Helping Others
Professional Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
5th Priority Focus
*
What is your 5th most important priority item?
Personal Growth/Development
Business Creation/Development
Career Development
Expanding My Network
Faith
Finances
Fun (Leisure Time)
Helping Others
Professional Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
What do you want?
What do you consider to be your primary focus professionally?
*
Sustaining your career
Advancing your career
Starting your business
Growing your business
Sustaining your business
What is the most significant goal, that if worked on consistently, would give you the greatest sense of accomplishment when you look back on your life 3 years from now?
*
What do you hope to receive most from PUSH to assist with accomplishing your most significant goal?
*
Accountability
Community Support
Competition
Guidance/Instruction
Increased Focus
Networking
Perspective
Planning/Structure
Sense of Urgency
Submit