Step 2 of 4

Confidential Genius Network® Application

This field is hidden when viewing the form

Email(Required)

Company Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Mobile(Required)

Do we have permission to send you updates via SMS messages?

Yes

Website(Required)

Industry(Required)

Are You The Owner/CEO/Founder of this company?(Required)

Yes

What is your business's Annual Gross Revenue?(Required)

Have you ever sold/owned another business?(Required)

Yes

Please Confirm The Following Statements:(Required) If I am approved for Genius Network®, I understand tuition is a $35k Annual Investment in myself and my business. And, I acknowledge that this investment is not a financial burden on me or my company’s cash flow. If I am approved to attend the Genius Network Annual Event, to Connect and Collaborate with Members, and experience what Membership could be like for me, I understand tuition to attend the Genius Network Annual Event, if I am not yet a full Member, is $15k, and that at the Annual Event if I chose to become a full Member I can upgrade (at the Event) for $20k.

Please Confirm The Following Statements:(Required)

Yes