Step 1 of 9 11% Currently I am:* Working as a CEO Retired or sold my company Working in a C-Suite or VP-level role A business owner who built my company A current executive coach or business coach My biggest challenge in my role right now is:* I’m burnt out in my current role I’m bored in retirement I’m tired of the stresses of entrepreneurship I’m a VP or C-Suite who wants advancement I want to own my own business or practice My professional situation is best described as:* I feel like I’ve hit a wall in my professional or personal life I just can’t see myself remaining retired I can’t see a path forward with my company and wanted to build something that was my own I built my own business but I feel like I have more to offer I’m feeling drained and am looking for support In my business life, I find I’m most driven by:* Driving results, purposeful work and building a business. Leaving a legacy and staying relevant. Connecting with others, listening and unearthing helpful insights. Financial freedom and impacting my generation of leaders. My desire to help others reach their full potential. The most Senior Role I’ve ever held was:* CEO C-Suite Executive or Vice President Business Owner or Co-Founder Executive Coach What led me to look into Vistage?* Vistage’s prestige as the top coaching organization in the world. Vistage is a way to stay in the game and secure my post-retirement future. Vistage’s business model is proven and doesn’t seem risky. Vistage offers a way to build my credibility as a leadership authority. I want to spend more time empowering CEOs and I need Vistage’s support. I have __ years of C-level, VP or Owner experience* 5-9 10-14 15-20 20+ The highest amount of revenue I’ve controlled is ___* 1-2M 3-4M 5-9M 10-20M 21-49M 50-99M 100M+ What is Your First Name?*What is Your Last Name?*What is your Email Address?* Postal Code*This field is hidden when viewing the formHIDDEN PhoneThis field is hidden when viewing the formHIDDEN CountryUnited StatesAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua & DepsArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia HerzegovinaBotswanaBrazilBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCape VerdeCentral African RepChadChileChinaColombiaComorosCongoCongo (Democratic Rep)Costa RicaCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIreland (Republic)IsraelItalyIvory CoastJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar, (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaSt Kitts & NevisSt LuciaSaint Vincent & the GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad & TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweThis field is hidden when viewing the formHIDDEN How many years experience do you have as a C-level executive?0-1011-1516-2020+This field is hidden when viewing the formHIDDEN What is the most senior executive role you have held?PresidentCEOOwnerFounderPrincipalManaging DirectorRegional PresidentCOOCXO (CFO, CMO, CIO, CTO, CHRO, etc.)VP – Only VPs with heavy P&L experience will be consideredThis field is hidden when viewing the formHIDDEN Your NameThis field is hidden when viewing the formHIDDEN Persona TypeNameThis field is for validation purposes and should be left unchanged. Δ
