Rest of Life Application Form

Full Name*

First NameLast Name

Preferred Name (if different) & Pronouns*

This may be a nick name or anything different from above name. Please retype your name if not different.Preferred gender pronouns.

Contact Number (Not shared with anyone. Phone number used in case there are connectivity issues during a scheduled Zoom call.)*

Please enter a valid phone number.Format: (000) 000-0000.

Email Address (This is not shared with anyone, except for the person who will fulfill your custom herbalism formulas.)*

example@example.com

I am applying as:

Address (will be used for shipping herbalism formulas)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you find Rest of Life? The more specific, the better. If someone referred you, please tell me who so I can thank them!*

This program involves scheduling 9 live 45-minute calls. I schedule these on an every other week basis once we begin and they happened on Mondays, Tuesdays or Thursdays between 9:am and 4:pm EST / 6:am and 1:pm PST or Tuesdays at 7:pm EST / 4:pm PST. Please list what times will work for you.*

Please describe in 2 to 5 sentences why you're looking to do this program at this particular time.*

This program involves some homework, with deadlines so that you can have an experiential learning process and I can offer customized herbalism formulas in time to work with them during our time together. Additionally, I will sometimes send you videos to watch. Will you be able to set aside approximately 2 hours a week (sometimes much less, sometimes slightly more) to do this work?*

After you complete this form and submit payment below, we'll jump start! I'll send you your first homework assignment within 2-business days and we will schedule our calls! The first assignment needs a full week because you'll be observing yourself each day to capture some elements of your life. Are you ready to commit to your live call times, and begin assignments?*

Do you have any initial questions and/or are there any accommodation needs that I can assist you with?

My Products

Rest of Life program: full program payment

Select this option if you are going through the program solo and want to pay in full.

$1,600.00 Quantity

Rest of Life program: 4-month payment plan

Select this option if you are going through the program solo and want to use a payment plan.

$400.00 Quantity

Rest of Life program, with a pal: full program payment

Select this option if you are going through the program with another person and want to pay in full.

$1,400.00 Quantity

Rest of Life program, with a pal: 4-month payment plan

Select this option if you are going through the program with another person and want to use a payment plan.

$350.00 Quantity

Total

$0.00

Credit Card

Please select this to indicate you've read the above directions to email Quai if you don't receive an email within 2 business days.