BPM Coaching Membership Application

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

What is your motivation in joining our coaching program?Or what caught your interest from your interactions with us?

5

What have you tried so far?* This field is required.Books, therapy, programs, et.c.

6

How long have you been a part of mens' groups?* This field is required.

Never

Less than 6 months

Less than a year

Over a year

7

Can you invest six months worth of membership in yourself?* This field is required.Or can you borrow to make that investment?

YESNO

8

Can you invest 10 + hour every week in yourself?* This field is required.Or reorganize your life to have that time.

YESNO

9

When can you start?* This field is required.

Today

In 2 weeks

In a month

In three months or beyond

10

Would you like to receive our newsletter?* This field is required.With articles and videos related to relationships and self growth.

YESNO