You're applying for Love Champ Boot Camp
Thank you for your interest! This application form helps us determine if our program is the right fit for you. We will reach out to you within 3 working days.
Name
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First Name
Last Name
Date of Birth
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dd-mm-yyyy
Nationality
What is the main thing you'd like to achieve from our training?
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Could you tell me some more about the (current) challenges, obstacles and/or feelings you are experiencing within your love life?
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What do you believe you need the most help with?
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On a scale of 1 - 10, what grade would you give your love experience right now?
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On a scale of 1 - 10, how committed are you to taking your love-life to the next level and to overcoming the challenges you communicated above?
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Do you have a sincere desire for a loving, mature and respectful soul-relationship?
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Yes
No
Are you open and willing to change and let go of the struggle?
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Yes
No
Do you understand that it's your own responsibility to implement what you learn and no one else is responsible for your decisions or progress?
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Yes
No
To reserve your seat we ask for a deposit of €555. If for some reason you can't join us anymore, you will receive your deposit back. In that case, make sure you cancel 14 days prior to our starting date.
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Understood
Leave your e-mail address below and we will soon be in touch with you about your application and next steps.
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example@example.com
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