6 MONTH COACHING - APPLICATION FORM
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Your Name
*
Your Email
*
Country
*
Afghanistan
Afghanistan
Algeria
Albania
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Armenia
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Chad
Chile
China
Colombia
Congo
Costa Rica
Ivory Coast
Croatia
Cuba
Czech Republic
Denmark
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Great Britain
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kosovo
Kuwait
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Tibet
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Ugandax
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna Islands
Yemen
Zambia
Zimbabwe
Age Range
*
18-25 years old
18-25 years old
26-35 years old
36-45 years old
46-55 years old
Over 55 years old
What's your skype username?
*
Preferred language for this call
*
English
Spanish
Why do you want to apply for this program?
*
What are your goals with this program?
*
Can you honestly afford the program?
*
Yes
No
Is this a comfortable, medium or high stretch for you?
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Comfortable
Medium
High
Which Payment Option do you prefer?
*
Full Payment (10000 USD)
Full Payment (10000 USD)
Payment Plan (3 x 4000 USD)
Full Payment with Upgrade (13000 USD)
Payment Plan (3 x 5000 USD)
On a scale from 1-10 how willing are you to invest in your transformation?
5
Any additional questions or comments for Sherina while she considers your applicaction?
*
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