Breakthrough Application

Your Breakthrough Application
Take your time and fill out this questionnaire completely and insightfully. Steve is very selective about his breakthrough clients.

When you are ready click "Next".
Your Contact Info
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Your Skype Name

Now
What are the biggest challenges you feel are holding you back in your life?*
What would make our time together a life- or career-changing experience for you?*
What do you hope to achieve by going through a Breakthrough Experience with Steve?*
What’s missing from your life and/or business? And, how do you keep it out?*
What is your Big Talent — the thing you are best at and enjoy doing and that requires relatively little effort from you?*

The Future
The Impossible: What would you like to accomplish that looks impossible, but if it were achieved would change everything?*
The Extraordinary: If you were to look back 3 years from now, and say “Hiring Steve as my coach was one of the best decisions in my life...” what has to have happened, personally and professionally, for you to feel thrilled with your progress?*
The Upper Limit: If in 3 years time you are disappointed with your results, why will that be? eg. unhealthy relationships, poor habits, limiting beliefs, fear of success.*

Yes or No?

If you can't honestly agree to all these statements, Steve will not be your best choice for coaching.
Click each to agree...*

I am willing to be coachable and take responsibility for my life and my choices.I am willing to be afraid and take action anyway.I am willing to face my darkness to find the light on the other side.I am open to honest feedback.I am open to creating change even if it is uncomfortable.I am willing to be vulnerable and open with myself and my coach.
Is there anything we forgot to ask you would like us to know?

A Breakthrough Experience is a minimum $10,000 investment. Is this within your budget?

YesNoI will make it happen
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Your Breakthrough Application