By becoming a Pinnacle Forum Partner, I promise to:
√ Use my sphere of influence in my community and our nation. Employ personal resources to transform lives, communities and our local and national culture.
√ Actively participate in a Forum and other Pinnacle Forum events.
√ Share the Good News of Jesus Christ with other influencers. Pray regularly for God to bless Pinnacle Forum’s Partners and their impact on our culture.
√ Keep any information or knowledge gained about any Pinnacle Forum Partner or participant confidential.
√ Acknowledge that I am a steward of God’s money and will contribute at least $1,500 per year or $125 per month to the Pinnacle Forum movement.
√ Not self-promote my business or organization to other Pinnacle Forum Partners, as well as refrain from using social media in a way that harms Pinnacle Forum.
What we believe: (Click to read our Statement of Faith)
I agree to Pinnacle Forum's Statement of Faith *
Yes
No
Confidentiality:
Any information shared by a Partner or participant in a Forum, including the names of the people in the Forum, must be held 100% confidential.
I commit to 100% confidentiality, which I understand is forever *
I agree
I Meet At Least Four Of The Six Partner Requirements:
I am recognized as, or can communicate as a peer at high levels of leadership in my sector.
Yes
I am or have been in a senior management position of a company or organization within my sector.
Yes
I serve or have served on the board of, or participate at a high level of governance in an entity in my sector.
Yes
I am a recognized authority in my sector having contributed to growth or change by articles written, books published or talks given which have contributed to growth or change within my sector.
Yes
With personal phone calls I can convene a meeting of other Pinnacle Forum Partner type leaders within my community.
Yes
I have the ability, willingness and desire to steward the influence God has entrusted to me and to employ my time, treasure and talents to transform lives and culture.
Yes
Seven Mountains of Culture:
Selecting your seven mountain(s) will assist with more strategic connections and provide you with communications that align with your interests.
I am Most Passionate About the Following:
Arts & Entertainment
Business
Education
Family
Government & Military
Media
Religion
Unknown
Personal Information:
Prefix
Dr.
Miss
Mr.
Mrs.
Ms.
Mx.
First Name *
Middle/Initial
Last Name *
Suffix
Birth Date
/ / (mm/dd/yyyy)
Home Address *
City (If outside US, type NA) *
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Zip *
Country *
United States of America
Canada
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia (Plurinational State of)
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo (the Democratic Republic of the)
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czechia
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands [Malvinas]
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran (Islamic Republic of)
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea (the Democratic People's Republic of)
Korea (the Republic of)
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia (the former Yugoslav Republic of)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova (the Republic of)
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan (Province of China)
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom of Great Britain and Northern Ireland
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela (Bolivarian Republic of)
Viet Nam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara*
Yemen
Zambia
Zimbabwe
Territory
Address Type *
Home
Work
School
Other
Mobile Phone *
LinkedIn URL (NA if no account) *
Opt-in To Receive Our Text Messages:
*SMS: Pinnacle Forum will send 4-8 text messages per month. Msg & data rates may apply per your plan. Text STOP to cancel any time.
Home Phone
Work Phone
Primary Email *
Alternative Email
Gender *
Female
Male
Spouse First Name
Married/Single
Married
Single
Spouse Email
How You Learned About Pinnacle Forum:
Select an Option *
LinkedIn
Facebook
Found Pinnacle Forum's website
Referral or Other
Stewarding Your Influence Podcast
Please add other source here or person's name of who referred you *
Organization Information:
Organization (or NA) *
Title (or NA) *
Organization Address
City
State
Zip
Web Site
The Forum You Are Attending:
Name of Forum You Are Attending (or N/A)
Name of Forum Facilitator
Your Partner Donation Options:
Pricing Terms *
YSL Introductory Offer Join
Partner Monthly Donation $125 Join
Partner Yearly Donation $1,500 Join
Colson Fellows Partner Monthly Donation Join
Please Create Your Login:
*We recommend a strong password with at least 8 characters, a capital letter, number and special character.
Login Name *
Login Password *
Retype Password *
By Submitting This Form, You Are Signing Electronically:
I agree to the statements in my Partner Commitment form and that the information I have provided is honest and complete to the best of my knowledge *
Yes
My Electronic Signature (full name) *
If you see an image type the characters as they appear in the image.