10 Rings of Power Manifesto
Please complete this form so we can determine if this information is a match to your level of goals and needs.
Your Name
*
First Name
Last Name
Email
example@example.com
Phone Number
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Country
Afghanistan
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eSwatini
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Tanzania
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US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
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Zimbabwe
Please indicate how you feel about the following:
Fully Satisfied
Doing Great
Neutral
Could Use Help
Very Discouarged
Wealth
Attraction Skills
Well-Being
Relationships
Physical Health
My Current Yearly Income (USD)
Over $1,000,000
$500,000 - $1,000,000
$250,000 - $500,000
$100,000 - $250,000
I have budget side aside for education and training.
Yes
No
I have had previous experience with personal coaches.
Yes
No
I've had previous experience with mastermind groups.
Yes
No
Please rate your ability to make money.
1
2
3
4
5
Please rate your ability to connect with people
1
2
3
4
5
Please rate your Law of Attraction satisfaction
1
2
3
4
5
Please rate your spiritual satisfaction
1
2
3
4
5
I have a desire to grow my business
1
2
3
4
5
No Desire
Extreme Desire
1 is No Desire, 5 is Extreme Desire
I have a desire to create better relationships
1
2
3
4
5
No Desire
Extreme Desire
1 is No Desire, 5 is Extreme Desire
I have a desire to create change in my life
1
2
3
4
5
No Desire
Extreme Desire
1 is No Desire, 5 is Extreme Desire
I am comfortable making changes in my life
1
2
3
4
5
Not Comfortable
Very Comfortable
1 is Not Comfortable, 5 is Very Comfortable
Please describe what you wish to gain from working with Joe.
Please briefly describe your six month goals
Please describe your 1 to 3 year goals
Please describe your long term or legacy goals.
What do you want to have, do, or be?
What other information would you like Joe to know about you?
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