Your Name/Owner Name
*
First Name
Last Name
DOB
*
MM
DD
YYYY
Age
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
(###)
###
####
Primary Email
*
How did you hear about Power Circles?
Internet search
Referred by a friend
Facebook
Instagram
LinkedIn
Other
Business Name
*
Business Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Business Phone
(###)
###
####
Business Email
*
Website Address
Date Established
*
MM
DD
YYYY
Legal Structure
*
Sole proprietor
Limited Liabiltiy Company (LLC)
S-Corporation
Other
Business Ownership
*
Identify if your business is located within one of the following Franklin County areas:
*
Franklinton
Hilltop
Near East
Old Town East
Short North
South Linden
Wyland Park
Other
If other, please specify
Industry
*
Aerospace
Agriculture
Chemical
Computer
Construction
Defense
Direct Selling
Education
Energy
Entertainment
Financial Services
Food
Government
Healthcare
Hospitality
Information
Manufacturing
Media
Mining
Nonprofit
Telecommunication
Transportation
Water
Other
If other, please specify
Briefly describe your business
*
Last year's annual revenue (sales)
*
Number of Current Employees (FT, PT, and Total)
Total Household Gross Income
*
Number of Persons in Household
*
Power Circles Rules of Participation
*
1. Treat all other participants with respect.
2. Confidentiality: All information shared in Power Circles is confidential. Sharing another business’s proprietary information or another business owner’s personal information without that person’s documented consent is prohibited.
3. Participation: The value of a Power Circle is in the discussion, collaboration, networking and accountability the program is designed to provide. Attendance and participation are required.
a. Attendance: Minimum of 80% of sessions
b. Participation: Minimum of 95% of homework completion
c. Sessions will begin and end as scheduled. It is the individual participant’s responsibility to inquire about missed material.
4. Participants may not use Power Circle sessions to sell or promote their products to other participants. Additionally, participants may not directly market to (via mail, online, email, or other channels) without the consent of the other participants.
I have reviewed the rules above and agree to abide by them as part of my participation in Power Circles. I also understand that failure to abide by the rules may result in dismissal from the program.
Congratulations! You’re one step closer to scaling your business! Thank you for submitting your application to be considered for placement in a Power Circle. We will be in touch soon with next steps! If you need assistance sooner, please reach out to us at admin@wsbaohio.org
