MASTERMIND MONTHLY MEMBERSHIP REGISTRATION FORM

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WELCOME TO THE MONTHLY WELLNESS CIRCLE FOR MEN

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Name

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Phone

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Email address

example@example.com

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Social Media Handles

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Are you a current or former client of Dr. Curt?

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How did you hear about the program?

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Like-minded, positive, safe and secure membership is paramount for all of us. Can you describe why you would like to join this unique membership group?

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What, why & how do you plan to contribute to and receive from this unique group experience?

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Are you prepared to invest in yourself for at least 3 months to reap the full benefits and to contribute your unique personal value to the group? Note: Your answer will not impact your membership.

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CONFIDENTIALITY is a MUST!!! Will you promise to keep all things shared within the group confidential and commit to sharing and contributing from your fully expressed self?

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My Products

My Bag

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One Month Membership Payment/2- Group SessionsYou will be required to submit payment monthly (1st of each month) to remain active with your monthly membership (Prices are subject to increase after March 1, 2025)
$97.00Edit
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3-Month Membership Fee/6-Group SessionsThe current 3-monthly reduced investment rate may increase after March 1, 2025. Get locked in! Save by signing up for 3-months today.
$250.00Edit
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Pay-As-You-Go/Drop-in/Pay Per sessionPay-pullup-and be prepared to be poured into by a group of solide, prescreened brothers who are doing REAL collective healing work.
$77.00Edit
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Invoice ID

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Payment Methods

Debit Or Credit Card

Choose from one of the PayPal options to make your payment.