Mastermind Application

The Most Magical Secret Mastermind™ Application

Completion and submission of this application is required for you to be considered to participate in our mastermind group. Once received, you will be contacted by email or phone within 5 business days.

Michelle and Scott value your privacy and will keep all information provided in this application confidential.

The Most Magical Secret™ Mastermind Application

Full Name:

Email:

Phone:

How did you hear about our mastermind group?

What is your profession?

What is going on in your life at the moment that makes you want to join our mastermind?

What do you want to accomplish from our time together?

If money was not object, what would you do for free?

What is your current biggest fear?

List 3 gifts (characteristics/strengths) you will bring to our group work?

List 3 of your current areas of growth you hope improve from our time together?

How do you envision benefiting from listening to others as they share their life’s challenges, hopes, and dreams?

How do you envision benefiting from sharing with others about your life’s challenges, hopes, and dreams?

Your website:

Your currently available services, books, or offerings for others:

Resources you have used that you recommend to others for personal growth and why:

Please list any conditions or any limitations that could limit your participation in the group:

Have you been diagnosed with depression, schizophrenia, bi-polar disorder, epilepsy, personality disorder, or any other psychological conditions? If so, explain below and include current status, and name/phone of any current providers involved in your treatment:

Do you have a history of trauma (sexual or physical abuse, or exposure to life threatening situations), substance abuse, suicidal ideation or attempts? If so, explain below and include current status, and name/phone of any current providers involved in your treatment:

GET TO KNOW SCOTT BETTER

Follow him on his social media sites.

sgrossberg@hotmail.com

© Copyright 2008-2025 by Scott J. Grossberg, APC. All Rights Reserved.

COPYRIGHT NOTICE
The images and slogans (including but not limited to, "Thinking Magically," "Stop Wishing. Start Having," "I Am Safe and Loved," "Ancient Magic, Modern Tools," "No One's Mind is Safe," "Unlock The Magician That Lives Inside You," "Outcome Design System," "Chakra Coding," "Gnosis Code," "Gnosis Coding," "Shunyata Code," "The Power to Be All You Imagine," "Mindsets Restored. Attitudes Adjusted. Outlooks Polished," "I Will Win. Always," "I Bring Magic to Life," "Stress Management Accelerator," "Pivot Play with Scott Grossberg," "The Man Who Sees Tomorrow," and the "Imagination Whisperer" presented on this website are not in the public domain. They are the copyrighted and trademarked property of Scott Grossberg and Scott J. Grossberg, APC and are fully protected by U.S. and international copyright and trademark laws. These images and slogans, in whole or a portion of, may not be reproduced, copied, projected, used or altered in any way, alone or with any other item(s), by use of computer or any other electronic means, saved to a digital file for personal or commercial use, without the expressed written permission of Scott Grossberg. We protect our intellectual property interests. For further information or inquiries, contact us at sgrossberg@hotmail.com.

The Most Magical Secret™ Mastermind Application

Follow Us