WORK WITH ME 1-on-1–
MENTORSHIP FORM
Name
*
First Name
Last Name
What’s your Instagram @?
*
Email
*
example@example.com
Tell us a bit about yourself
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What are your goals in the next 6 months to a year?
Goals
*
.
Why do you think you should be accepted into the program?
*
Do you have 2 hours per day to make this work?
*
Please Select
Yes my schedule is flexible
No I don’t have much time
If you was accepted into the program , Do you have an investment to join tomorrow?
*
Yes I do
No I don’t
No but I will source the funds
How much investment do you currently have?
*
$0
$100
$300
$500
$1000
Other
Please verify that you are human
*
Submit
Should be Empty: