Exceptional Leaders Community of Practice
We're thankful for our supportive, wise, and diverse community of practice. We appreciate you completing this form to give us a better idea of the kinds of work on which we might collaborate.
Name
*
First Name
Last Name
Legal business name (if applicable)
Type of Business Entity
Individual/Sole Proprietor
Limited Liability Company
Corporation
Limited Partnership
Other
URL or LinkedIn
Email
*
example@example.com
Phone Number (enter 1 for US Country Code)
*
-
Country Code
-
Area Code
Phone Number
Street Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Street Address 2
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
ZIP Code
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
State of business registration, if different
Please list industries in which you have 1 or more years of coaching, consulting, or training experience.
Please check all certifications/trainings you have received:
*
New Ventures West / PCC
ICF - ACC
ICF - MCC
ICF - PCC
Leadership Circle Profile 360
Myers Briggs Type Indicator
Working Genius
Clifton Strengths
Enneagram
None of these
Other (e.g. MBSR, Strozzi, Coaching Circles, Team coaching, Equine work, etc.)
If you have consulting experience, briefly describe the extent, content, and industries in which you have consulted.
If you know someone who has worked with Exceptional Leaders or any of our team, please list them here. (See a list of our teammates at exceptionalleaders.com/about)
Is there anything else you'd like to share about your work?
Please list any food allergies/requests. We share this with our clients who provide meals and snacks during sessions.
If you'd like to share your bio and/or photo with us, please add them here.
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