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Last Name*
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Business Email*
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Professional Role*
Most recent annual sales revenue*
Company*
Phone*

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Leadership (Culture, Communication, Strategic planning)
Talent Management (Retention, Recruitment, Development)
Customer Engagement (Customer service, Sales, Market development)
Business Operations (Productivity, Technology, Infrastructure)
Financials (Financial management, Capital/cash management, Economic trends)
Personal Development (Leadership competencies, Work/Life balance, Exit planning)
What is the biggest challenge or opportunity you are facing right now?*
Number of employees*
Prior peer group experience?*
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Thinking about your role right now, which 2 statements best describe how you feel today?
Please pick unique statements.
First Statement*
Second Statement*
- Please have a Vistage Consultant contact me regarding membership options.
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