6 Weeks to Success: Apply for Personalized Coaching

1

Name* This field is required.

First Name

Last Name

2

Email address* This field is required.

example@example.com

3

Phone Number* This field is required.

4

Current occupation* This field is required.

5

How did you find this Coaching Program?* This field is required.

Referral

I'm inside the Community

Social Media

Nurse Lois Emails

6

As a result of proper coaching, how much income do you want to make monthly?* This field is required.

7

What is your current monthly income?* This field is required.

8

What is the main obstacle preventing you from your desired monthly income goal?* This field is required.

9

Are you a licensed life insurance agent already?* This field is required.

A) Yes

B) NO

10

Due to the volume of applications and time commitment, Program spots are limited to 10 students. Why should you be selected?* This field is required.

11

If you qualify, how much are you prepared to invest today in coaching?* This field is required.

A) $1000 - $2,000

B) $3,000 - $5,000

C) $6,000 - $9,000

D) $10,000+ (Whatever it takes)

12

What level of coaching are you most interested in?* This field is required.

Community + Course

Agent Accelerator (6-weeks)

Nurse Exit Plan (6-weeks)

Inner Circle Mastermind (6 Months)

13

The Program starts this upcoming week. Will you be available to participate?* This field is required.

A) Yes I am available to participate

B) No I cannot participate

14

We provide flexible funding options (if needed). How is your credit?* This field is required.

A) 599 or less

B) 600- 619

C) 620-700

D) 700+

15

What is your social media handle?* This field is required.

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