Pithaya Member Intake Form
Hi there - Congratulations on taking the first step towards finding like-minded peers who will support you during your business ownership journey. Entrepreneurship is hard, but no one woman should have to go it alone. 

It takes 3-5 minutes to complete the survey. Within the next few weeks, you'll receive an email with recommended connections based on your feedback - we're happy to faciliate an introduction between you and your connection or you can choose to reach out the them on your own.  

We'll never sell or share your data with third-party companies, but we may send you the occasional email or invitation to one of our events. 

Having a strong community is essential to every woman's success, and we want to make it easier for you to find your people. When we thrive, everyone around us benefits.

To more women entrepreneurs building impactful businesses, thriving and having each other's back along the way. 
Name  *
Email *
[Optional] Link to Scheduling Platform (e.g. Calendly, YouCanBookMe, etc)
Location (City and State) *
Business Name  *
Business Website *
Industry  *
Social Media Links (LinkedIn, Instagram, Tik Tok, YouTube, Facebook) *
Business Stage *
Team Size *
What are 3 things you do very well? 
(be as specific as possible!)
 *
What are 3 things you are challenged with, in your business? 
(be as specific as possible!)
 *
[Optional] Do you have a skill you'd be willing to trade with someone for support in an area of your business? If so, what swap would you propose?
What do you like to do outside of work?  *
Have you participated in other women's networking groups? If so, which ones?  *
Is there anything else you want us to know about you?  *
Last question! What type of events do you prefer? *
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