Platinum Mastermind Application Form

First Name

Surname

Company

Mobile Phone

Home Phone

Street Address

Town/Suburb

Postcode

Screening Questions

My biggest motivator for joining the Platinum Mastermind coaching and mentoring program at this time in my life is:

If I'm accepted, the reason I am absolutely committed to succeeding in this program right now is:

If I had to focus on just 2 things with this program, they would include:

The farming-based products that I am currently producing and marketing include (e.g. Sheep, Cattle, Crops, etc):

The number of full-time employees I currently have is:

Right now, the annual business income is approximately:

Right now, my business bank account balance is:

At the start of July, the total business debt (fixed and overdraft) is approximately:

Right now, the total personal debt (including credit cards) is:

Right now, I estimate the market value of all properties, plant, livestock and investments that I own is:

I believe my fastest route to financial independence in the next five years is for me to:

If I’m going to be financially wealthy, the first thing I have to START doing RIGHT NOW is:

If I’m going to be financially wealthy, the first thing I have to STOP doing RIGHT NOW is:

Please share any other reasons you feel you should be part of this program:

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