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
Phone
*
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
Date of Birth
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
/
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
YYYY
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Do you have children?
*
Yes
No
Are you a full-time or part-time business owner?
*
Full-Time
Part-Time
If part-time, please provide a brief description of your job title and duties. (ex. Title/Duties)
*
What is the name of your business?
*
Provide a brief description of your business and what services your provide.
*
Next
Team Awareness
PUSH is built upon a foundation of fostering a strong community, where each individual plays a crucial role in supporting one another's personal growth and productivity. By prioritizing individual improvement and productivity, we contribute to the collective strength and success of our cohesive unit. Together, we can achieve far greater results than we could ever accomplish alone.
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 actively participate, support, encourage, and freely share information with other members of the PUSH community to enhance the overall dynamics of the community?
*
Yes
No
What does it mean to you to be a team player?
*
Why is it important to you to have and grow a successful business?
*
Items Knowledgeable About
Please share the areas where you feel you have expertise or knowledge. These might come from your professional experience, skills you've developed, or personal interests. Essentially, where could you potentially help others?
1st Item (Experienced In/Knowledgeable About)
*
2nd Item (Experienced In/Knowledgeable About)
*
3rd Item (Experienced In/Knowledgeable About)
*
Next
My Hobbies
Please list your 3 favorite hobbies or pastimes?
Hobby 1
*
Hobby 2
*
Hobby 3
*
Items Your Consistent With
Please identify three (3) activities that you consistently engage in and provide a brief explanation for each. These activities can include spending time with family/friends, exercising, reading, leisure activities, working on your business, financial planning, pursuing career-related goals 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 (business, health, or relationship based) that have been on your "to-do" list for three months or longer, tasks you have been procrastinating on. Examples can include making time for personal development, establishing a regular exercise routine, dedicating intentional time with your kid(s)/significant other, or delegating items to free up more of your time.
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: Some examples are spending time with family/friends, exercising, reading more, working on your business more, developing skills, financial planning, etc.
Desired Consistent Item 1
*
Desired Consistent Item 2
*
Desired Consistent Item 3
*
Next
Personal and Business Improvement
What areas of your personal and business life are you currently seeking to improve? Please prioritize and identify your top 4 focus areas in order of importance to you.
1st Priority Focus
*
What is your most important priority item?
Personal Growth/Development
Business Growth/Development
Physical Fitness/Nutrition
Relationships (Family)
Relationships (Friends/Sig Other)
Faith
Expanding My Network
Helping Others
Finances
Professional Development
Fun (Leisure Time)
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)
What do you want?
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
Build Meaningful Connections
Community Support
Competition
Guidance/Instruction
Increased Focus
Perspective
Planning/Structure
Sense of Urgency
Submit