Interest Form
** We will schedule a 15-30 minute session to meet prior to the group starting to ensure that the group is an appropriate fit.**
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
What is the best way for me to contact you?
*
E-mail
Phone Call
Which group time were you interested in?
*
Wednesday evenings, Starting February 11th @ 6:00 p.m. MT (*May skip March 4th)
Wednesday evenings, Starting April 1st @ 6:00 p.m. MT
Tuesday mornings, Starting April 21st @ 9:00 a.m. MT
Wednesday evenings, Starting September 9th @ 6:00 p.m. MT
Wednesday mornings, Starting November 4th @ 9:00 a.m. MT
Tuesday evenings, Starting November 10th @ 6:00 p.m. MT
I am interested in the group, but the timing doesn't work for me in this moment!
If you selected that the timing doesn't currently work for you, please suggest a day and time that you would like to see an offering:
Agreement to Cost & Commitment (Must select all)
*
I understand that the cost is $50/session. (Paid via credit card on file after each group time)
I understand this is a 6- week group, and the success of the group is based upon all members fully contributing.
I understand that each group will be 60 minutes long.
I understand that the group may be cancelled if fewer than 4 participants enroll.
What is your main goal for joining this group?
*
Would you like to be notified of future groups or other financial therapy information?
*
Yes
No
Where did you hear about this group?
*
Please denote if you received a coupon from a conference that you would like to utilize.
Anything that you want me to know?
Submit
Should be Empty: