COACHING SERVICES APPLICATION FORM Name * First Name Last Name Phone * (###) ### #### Email * Time Zone * Pacific Time (PT) Pacific Standard Time (PST) Mountain Time (MT) Mountain Standard Time (MST) (UTC-7) Central Time (CT) Central Standard Time (CST) (UTC-6) Eastern Time (ET) What is your Instagram Handle/Username? * What coaching service/services are you interested in? (select all that apply) * Mindful Gold Digging 1:1 Coaching Program - $1751 (Financing Options Available) 90 Minute Coaching Call + A Full Week of Voxer Support Messaging - $697 (Financing Options Available) 90 Minute Coaching Call ($197 per call) Group Coaching What do you feel is getting in the way of accomplishing the life you dream of? * Why is right now the time to invest in yourself and/or your business idea? * Are you prepared to invest in yourself and your dream at this level? Yes! I'm tired of doing things my way and will pay whatever it costs to accomplish my goals! Yes and I would like to discuss payment plan options! I am scared but I know that the way I've been going hasn't been giving me the results I want. I am not ready to invest myself at this time. How did you find me? * Thank you!