Name *

First Name

Last Name

What best describes your current role? *

Individual Contributor (ready to step into leadership)

Mid-level Manager

Director or Senior Manager

Executive (VP or above)

Other (please specify)

How many years of leadership or management experience do you have? *

None

1–3 years

3–7 years

8+ years

What’s your biggest goal for the next 6–12 months? (Select all that apply) *

Get promoted or expand into a bigger leadership role

Gain visibility and recognition from senior leaders

Build executive presence and communicate with confidence

Clarify my leadership brand and voice

Lead more strategically and influence outcomes

I’m not sure, but I know I’m ready for more

When things don’t go your way at work, which response feels most like you? (Select all that apply) *

I pause, reflect, and focus on what I can influence.

I analyze what happened and use it to plan my next move.

I feel frustrated or stuck - I usually need some time to process what could have been done differently.

I seek input or advice from others to help me move forward.

On a scale of 1–5, how open are you to trying new tools, new frameworks and concepts, and receiving honest feedback? *

(1 = very hesitant, 5 = completely open)

I tend to feel intimidated by new approaches and prefer sticking with what I know

I’m cautious but curious, and open if I see a clear benefit

I’m willing to try new things even if they feel uncomfortable at first

I usually welcome new ways of thinking and appreciate constructive input

I embrace feedback and new ideas with open arms — it’s how I grow

Do you have the time and energy to commit to a focused 8-10 week leadership workshop right now? *

Yes, I’m ready

Maybe, depending on the schedule

Not at the moment

Which salary range best reflects your current compensation (base + bonus, if applicable)? *

Under $99,999

$100,000-$149,999

$150,000–$199,999

$200,000–$249,999

$250,000+

Prefer not to say

I agree to attend both days on time: Monday, July 28 and Tuesday, July 29 at 11 AM CST. *

Yes, I'll be there!

No, the timing doesn’t work for me.

No, the training isn’t for me.

I agree to attend the event with my camera on and I'll be ready to engage with other participants *

Yes, I'll attend with my camera on.

No, thank you. This is not for me.

I agree, that in exchange for this live training, to attend a feedback call with Janet so I can share my insights from the event and explore next steps with my offer. *

Yes, I commit to a feedback call.

No, thank you. The training isn’t for me at this time.