APPLY TO BWK ALLIANCE

1

ARE YOU A BLACK MAN?* This field is required.Black Warrior King Alliance s personal development Tribe for Black men

YESNO

2

Name* This field is required.

First Name

Last Name

3

Email* This field is required.

example@example.com

4

Phone Number* This field is required.

Area Code

Phone Number

5

ARE YOU MARRIED?* This field is required.

YESNO

6

DO YOU HAVE CHILDREN?* This field is required.

YESNO

7

HOW DO YOU EARN INCOME?* This field is required.

8

WHAT IS YOUR INCOME RANGE* This field is required.

9

HOW DO YOU HONESTLY RANK YOUR FITNESS LEVEL?* This field is required.

Poor - UnHealthy - Overweight

Average - Healthy - On Weight

Athletic - Strong - Lean & Fit

10

WHICH AREAS IN YOUR LIFE REQUIRE SIGNIFICANT GROWTH* This field is required.

FAITH - SPIRITUALITY - CONNECTION

FAMILY - WIFE & CHILDREN - RELATIONSHIPS

FITNESS - HEALTH - PHYSICALITY

FINANCE - WEALTH - INCOME

FUTURE - LEGACY - CHARITY

11

HOW HAS YOUR LIFE BEEN IMPACTED BY RACISM?* This field is required.

Extremely Impacted - Very Concerned

Slightly Impacted - Concerned

Minimally Impacted - Slightly Concerned

Not Impacted - Not Concerned

12

If You Could Ask Lerrod Any Question or Tell Him Something Personal Regarding This Application What Would It BeSHORT & TO THE POINT