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Workshop & Life Coaching Registration Form
Form used to register users who would like to attend or book workshops, work with accountability partners, or receive life coaching. Collects basic information like name, email and phone number, as well as details surrounding your chosen workshop.
10
Questions
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1
Full Name
*
This field is required
First Name
Last Name
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2
Company, school, organization, or group name.
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3
Address
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4
Phone Number
*
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Area Code
Phone Number
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5
E-mail
*
This field is required
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6
Workshop or Product Name
Select the workshop(s) or product(s) you are purchasing. (You may select multiple)
G.R.E.A.T. S.T.A.R.T. Full Session
We V.O.W. Full Session
G.R.E.A.T. S.T.A.R.T. 2-day Crash Course
We V.O.W. 2-day Crash Course
Professional Skills
DestinMe Purpose Planning
Life-onomics: Dollar Decisions
Vision 4 Life Vision Board
Social Media Image Mgmt.
Motivation/Empowerment
Confidence Building
Job Search/Career Development
Other Topic
Life Coaching Session(s)
iCountability Partner Sessions
G.R.E.A.T. S.T.A.R.T. Full Session
We V.O.W. Full Session
G.R.E.A.T. S.T.A.R.T. 2-day Crash Course
We V.O.W. 2-day Crash Course
Professional Skills
DestinMe Purpose Planning
Life-onomics: Dollar Decisions
Vision 4 Life Vision Board
Social Media Image Mgmt.
Motivation/Empowerment
Confidence Building
Job Search/Career Development
Other Topic
Life Coaching Session(s)
iCountability Partner Sessions
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Enter
7
Suggestions or topics you would like to be included in the workshop, accountability sessions, and/or life coaching?
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Normal
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Huge
Bold
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Created with Sketch.
Underline
Created with Sketch.
Underline Copy
Created with Sketch.
Ok
NumberList Copy 2
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quote
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Break
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Image
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Ok
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8
My Products
*
This field is required
My Bag
0
My Bag
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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Great Product Name
$20
Quantity:
1
Size:
Small
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ORDER SUMMARY
Tax
USD
Subtotal
USD
Total cost
USD
iCountability Partners Premium Monthly Rate (8 sessions per month; 3 month minimum)
$
200.00
+
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Quantity
iCountability Partners Gold Monthly Rate (6 sessions per month; 3 month minimum) 2
$
175.00
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Quantity
iCountability Partners Silver Monthly Rate (Once per week; 3 month minimum) 3
$
145.00
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iCountability Partners Bronze Monthly Rate (Every other week; 3 month minimum) 2
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100.00
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Quantity
G.R.E.A.T. S.T.A.R.T. Full Workshop (6 weeks - CZD Hosted)
$
210.00
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We V.O.W. Full Workshop (6 weeks - CZD Hosted)
$
210.00
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G.R.E.A.T. S.T.A.R.T. 2-day Crash Course (CZD Hosted)
$
125.00
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We V.O.W. 2-day Crash Course (CZD Hosted)
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125.00
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2-day Workshop + WFLCS + t-shirt (CZD Hosted)
$
125.00
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2-day Workshop + WFLCS + t-shirt (Traveling Workshop - Group 10+)
$
85.00
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1-day Workshop + WFLCS (CZD Hosted)
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75.00
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1-day Workshop + WFLCS (Traveling Workshop - Group 10+)
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50.00
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Life Coaching Session (per hour)
$
100.00
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Date
Date
Year
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Date
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Time
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