Membership Application

1Administrative Information

2Team Dynamics

3Self-Awareness

4Improvement Areas

Name *

First

Last

Email *

Confirm Email

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth *//

Do you have children? *

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. *

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? *

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? *

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) *

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 *

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 *

2nd Priority Focus *

3rd Priority Focus *

4th Priority Focus *

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