Bridgewater Leads Groups Application Form

1

Contact Information

Business contact information for the applicant.

Preferred Leads Group * First Name * Last Name * Email * Phone Number *

2

Business Information

Business details, category, online presence, and location.

Business Name * Title / Position * Main Business Category * Specialty / Seat Business Website Instagram Profile Any other social media profile Address Line 1 Address Line 2 City State Zip Code

Briefly tell us about your business * What do you hope to gain by joining this group? *

Does your profession require a license? * Yes No

3

Referral Fit

Help leadership understand your referral network.

What types of businesses typically generate referrals for you? * Who is a good referral partner to you? * What types of businesses do you provide referrals for? *

Do you belong to other lead generation groups or networking organizations? Yes No

4

Member Commitment

Confirm the core commitments expected from Leads Group members.

Can you commit to attending a Leads Group twice a month? * Yes No

Can you commit to at least two 30 minute 1-on-1 meetings per month? * Yes No

How did you hear about Bridgewater Leads Group? How will you contribute referrals or support the group? Why do you want to join Bridgewater Leads Groups?

Bridgewater Leads Groups Application Form

Apply for membership

Contact Information

Business Information

Referral Fit

Member Commitment