Course Registration Form

Manifesting Love Application

Please answer each question thoroughly for consideration.
Client Name*

First NameMiddle NameLast Name
What are your pronouns?
Birth Date*

MonthDayYear
Birth Time & Location *
Required - if you do not know your birth time, enter 12:00am
Relationship Status*
Mailing Address (p.o. boxes are okay!)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Mobile Number*
Phone Number (if different from mobile)
Location*
Have you taken any personal growth seminars/workshops or had coaching before? If so, what helped you the most in those settings? What areas do you think you need to grow in order to manifest love?*
Do you have any aversion to spirituality? If so, please explain.
What ideas or beliefs did you grow up with about marriage, religion and sex? Do those ideas or beliefs resonate with you now? Why or why not?
What are you TOP 3 Favorite places to visit, foods, films and books? What makes them special to you? (in no particular order)
How do you describe yourself?

Introvert (100%)Extrovert (100%)Ambivert (a blend)
Tell me about your last 3 relationships. What did you learn about yourself? Do you have any remaining energetic attachments with those people?
Have you had any form of energy work over the last ten years? Did you love it? If no, why not? If so, what did you experience?
Describe your "type". .
Manifesting Love (1:1 Coaching) requires a certain level of honesty and integrity (that goes for both of us). On a Scale from 1 to 10, 10 being stellar, what is your relationship with your Word today? (If it is not so stellar, are you willing to change that?)
Do you want the VIP experience or the Basic experience? (Needed for scheduling and invoicing)*
Manifesting Love (1:1 Coaching) is designed with your privacy in mind. I will not breach the confidentiality of our time together. Any sharing, for marketing purposes, will only occur with your written permission. Do you agree to honor the confidentiality as well?

YesNo
Manifesting Love (1:1 Coaching) requires a commitment to yourself and requires your participation. Do you agree to show up, give your all and complete the course?*
Signature*

Clear
Should be Empty:

Manifesting Love Application