Programs Application Form

Academy For Self-Mastery (ASM) Application Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number with country code.Format: (000) 000-0000.
APPLY NOW - Please select which program you would like to apply:*
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Practitioner/Coaching Training with Poppy - £1,500 per month
Apply for Practitioner/Coaching Training with Poppy.

£ Free

Senior Coach Session - £180
Apply for a Coaching Session with a Senior ASM Coach.

£ Free

Total

£0.00
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What are your biggest challenges currently / Why are you applying to join?*
What is your current occupation?
First ExperienceSome ExperienceAlways Learning
UnsafeOk but need ImprovementGreat
Suicidal ThinkingDepressed / Low MoodAverageGood
ProblematicOk but needs improvementI'm happy with it
NoneHealthy AmountTotal People-Pleaser
TroublesomeOk but needs improvementI'm happy with it
What is that?Not for mePretty good but needs improvementGreat
What are you looking to achieve in your ASM Program?*
What's been stopping you from achieving this already (that you know of)? *
Where will your life be in 1-year if you don't invest in ASM, i.e. what will the costs and consequences be to you?*
1 Hour5+ HoursWhatever it takes to achieve my goals
£500 - £1,000£1,500 - £5,000£5,000 +Whatever it takes to reach my goals
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Academy For Self-Mastery (ASM) Application Form