Name:

Company/Organization:

Mailing Address:

Telephone Number(s):

Fax Number:

E-Mail Address:

Position/Title

Area of Responsibility

1. Our Group Mission and Purpose:

2. A "Mess" is an inter-related bunch of issues, problems, obstacles, challenges and opportunities. The Strategic Mess we are faced with is:

3. Some major issue and challenges imbedded in our Mess are:

4. Some Knowns we would like to explore with a Thinking Adventure are:

5. Some Unknowns we would like to explore with a Thinking Adventure are:

6. Why I feel a Thinking Adventure might work with our Mess:

7. Some specific output and results we would hope to return with are:

8. Potential backers and sponsors for this Thinking Adventure are:

9. Size of Group or Team:

10. Some near-term dates (next 4-8 weeks) that would work for us are:

11. Some locations that would work well for us are:

12. How did you learn about Thinking Adventures and Thinking Expeditions?

Please contact me to explore the next steps in planning an Adventure.