Heart Seat Application

Heart Seat Application
Submit this application to our staff to apply for a 15-minute coaching session.

If you are selected, you must be present and prepared to discuss your love life on stage when asked. If you are not selected, please rest assured that all of your information will remain confidential.
Name of Event In Which You're Participating*
NAME*
PHONE*
EMAIL ADDRESS*
example@example.com
Relationship Status*
Are you willing to be coached on camera?*

YesNO
How did you hear about Gladys & Michelle and Heart's Desire International?*
Have you participated in any of the following programs?*

Ready for Love Jump-StartReady for Love NOWReady to Love Again Yearlong ProgramKeeping the Love Alive Yearlong ProgramUnleashed RetreatNew Love in the New YearHeart's Desire Private VIP DayBE-YOU-tifully YOU ChallengeDating Detox ChallengeOther
Are you currently enrolled in any of the above programs?*

YesNo
1) Why did you choose to attend this event? (What were you hoping to learn/achieve?)*
2) What is the #1 challenge you are facing in your love life that you want to breakthrough and how is it impacting you (please be specific)?*
3) When it comes to your love life, please share what the most important goal or outcome you would like to achieve is. Focus on the kind of experience you want to create in your love life/relationship, and why is this important to you? (Please answer all 3 parts of the question, and be specific.)*
4) What are some of the things that have stood in the way of you achieving this goal and/or having this experience in the past? (Please be specific about fears, patterns, challenging live events, etc. that may have gotten in the way of you having the Extraordinary Relationship you desire.)*
5) How would your life change, and what would it mean to you and your life to achieve this goal? Why? (Take your time and be specific as you answer.)*
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