HAPPY COUPLES WIN Application

1

Please confirm your full name* This field is required.

First Name

Last Name

2

Please confirm your email address* This field is required.Please ensure you use the same given in the appointment booking.

example@example.com

Confirm Email

3

And lastly, please confirm your phone number* This field is required.

Please enter a valid phone number.

4

HOW LONG HAVE YOU BEEN IN YOUR RELATIONSHIP?* This field is required.

5

WHERE ARE YOU RIGHT NOW IN YOUR RELATIONSHIP?

6

WHERE DO YOU WANT TO BE?

7

WHAT IS YOUR BIGGEST OBSTACLE RIGHT NOW TO CREATING THE RELATIONSHIP YOU WANT?

8

WHAT ARE YOU DOING RIGHT NOW TO RESOLVE YOUR RELATIONSHIP ISSUES?

9

HOW LONG HAVE YOU BEEN STRUGGLING IN YOUR RELATIONSHIP?

10

WHAT IS YOUR CURRENT STATUS?* This field is required.

SELF EMPLOYED

EMPLOYED

STUDENT

UNEMPLOYED

11

RIGHT NOW I…* This field is required.

HAVE THE FINANCIAL RESOURCES TO INVEST IN MY RELATIONSHIP.

HAVE ACCESS TO THE FINANCIAL RESOURCES TO INVEST IN MY RELATIONSHIP.

I DON’T HAVE ANY FINANCIAL RESOURCES AT ALL AND I AM GOING TO STAY EXACTLY WHERE I AM.

12

IF SOMEONE ASKED ME TO SPEND MONEY ON MY RELATIONSHIP, I WOULD…

KNOW ITS WHAT ANYONE SERIOUS ABOUT THEIR RELATIONSHIP WOULD DO TO SOLVE THIS PROBLEM.

WOULD BE A LITTLE INTIMIDATED, YET WITH A PROVEN SYSTEM, I WOULD DO IT BECAUSE I AM SERIOUS ABOUT SOLVING THIS PROBLEM.

AVOID IT AT ALL COST BECAUSE I WANT TO DO THINGS AS CHEAPLY AS POSSIBLE.

13

COMPLETE THIS STATEMENT. " WHEN MAKING FINANCIAL DECISIONS, I..."*

MAKE THEM ON MY OWN

CONSULT MY SPOUSE

14

DO YOU PROMISE TO SHOW UP FOR YOUR SCHEDULED APPOINTMENT ON TIME AND DISTRACTION FREE? PLEASE CONFIRM BY TYPING, “YES I WILL” IN THE BOX BELOW.* This field is required.