VIP PLUS Application
1-on-1 coaching application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Current/ Future Business Location
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you currently own a licensed home care business?
*
Yes
No
If yes, are you working your business full-time?
Yes
No
If yes, which category are you?
Please Select
0 - 100 weekly billable hrs
110 - 300 weekly billable hrs
310 - 800 weekly billable hrs
1000 - 3000 weekly billable hrs
3000+ weekly billable hrs
How would you like Coach Michele and her team to help you?
*
The VIP PLUS is 1-on-1 coaching w/ Coach Michele. The investment is $25,000, are you financially prepared to invest at this time?
*
Yes
No
If no, wait until you are prepared financially to submit this form. Coach Michele accepts a limited number of clients to the VIP PLUS per year. This is not a call to learn more about the VIP PLUS. This is an application to be accepted as a 1-on-1 client.
*
I understand and would like to move forward and submit now.
I understand and would like to submit at a later date.
I would you like to learn more about the coaching program. Please have a representative to call me.
Submit
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