Application for 3 month 1-1 leadership mentorship

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Please tell me your name* This field is required.
First Name
Last Name
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Please tell me your email address* This field is required.
example@example.com
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Please tell me your Instagram or Facebook handle or username so I can reach out to say hello* This field is required.
Please enter a valid phone number.
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Where do you live?* This field is required.
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What kind of work do you do currently and is it aligned with what you ultimately want to do? Please explain...* This field is required.
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Knowing that everything you desire is possible for you, what is your deepest longing for yourself, lifestyle and business? Be specific..* This field is required.
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What fears or obstacles are currently standing in the way of you having that?* This field is required.
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Why do you feel you are struggling with this?* This field is required.
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Why do you feel now is the right time to change this?* This field is required.
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Why do you think working together could help you break through?* This field is required.
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How committed are you to invest energy, time, and money to your own exponential growth?* This field is required.
I'm deeply committed and ready to be 100% in.
I want to change but I'm afraid to commit fully
I'm not ready to commit to change, I'm just curious
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The investment for this leadership program is either €4,000 upfront, or 3 monthly payments of €1,467 (for private & Dutch business clients VAT 21% is included) - Is this possible for you?* This field is required.Please note -
Yes, I'm 100% ready and able to invest
Saying yes to this program will put me in financial burden
I'm not able to invest at this level yet.
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Would like to pay in 1 or 3 payments?* This field is required.
I will pay €4,000 in full and save €400
3 monthly payments of €1,467
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If you want to sign up under your company, please share your company name and VAT number so we can set up the right invoice for you.
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Thank you so much for sharing all this with me love. Do you want to add anything that I didn't ask about?* This field is required.
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