Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
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Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Name
Have you written a book before?*
*
What topic would you write about, if chosen for this opportunity? (it has to be around the theme of Revitalize Your Soul)
*
Why do you deserve to be chosen as one of the 10 authors for this opportunity?
*
Please Select
*
I am willing to write a chapter in the upcoming book "Revitalize the Soul"
I am willing to speak on stage with Kim Groshe at the launch event
I understand that this program has a cost of $6,500 and, if selected, will need to sign a contract and submit the deposit of $2,179 to confirm my spot.
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