Adult or Group Registration Form

1
Full Name* This field is required.
First Name
Last Name
2
Company, school, organization, or group name.
3
Address
Huge
Large
Normal
Small
Ok
Ok
4
Phone Number* This field is required.
Area Code
Phone Number
5
E-mail* This field is required.
6
Workshop or Product NameSelect 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
7
Suggestions or topics you would like to be included in the workshop, accountability sessions, and/or life coaching?
Huge
Large
Normal
Small
Ok
Ok
8
My Products* This field is required.
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
TaxUSD
SubtotalUSD
Total costUSD
iCountability Partners Premium Monthly Rate (8 sessions per month; 3 month minimum)
$200.00+Remove
Back
3
3
4
5
6
7
8
9
10
11
12
Quantity
Subtotal: $0.00
iCountability Partners Gold Monthly Rate (6 sessions per month; 3 month minimum) 2
$175.00+Remove
Back
3
3
4
5
6
7
8
9
10
11
12
Quantity
Subtotal: $0.00
iCountability Partners Silver Monthly Rate (Once per week; 3 month minimum) 3
$145.00+Remove
Back
3
3
4
5
6
7
8
9
10
11
12
Quantity
Subtotal: $0.00
iCountability Partners Bronze Monthly Rate (Every other week; 3 month minimum) 2
$100.00+Remove
Back
3
3
4
5
6
7
8
9
10
11
12
Quantity
Subtotal: $0.00
G.R.E.A.T. S.T.A.R.T. Full Workshop (6 weeks - CZD Hosted)
$210.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Quantity
Subtotal: $0.00
We V.O.W. Full Workshop (6 weeks - CZD Hosted)
$210.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Quantity
Subtotal: $0.00
G.R.E.A.T. S.T.A.R.T. 2-day Crash Course (CZD Hosted)
$125.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Quantity
Subtotal: $0.00
We V.O.W. 2-day Crash Course (CZD Hosted)
$125.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Quantity
Subtotal: $0.00
2-day Workshop + WFLCS + t-shirt (CZD Hosted)
$125.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Quantity
Subtotal: $0.00
2-day Workshop + WFLCS + t-shirt (Traveling Workshop - Group 10+)
$85.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Quantity
Subtotal: $0.00
1-day Workshop + WFLCS (CZD Hosted)
$75.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Quantity
Subtotal: $0.00
1-day Workshop + WFLCS (Traveling Workshop - Group 10+)
$50.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Quantity
Subtotal: $0.00
Life Coaching Session (per hour)
$100.00+Remove
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Quantity
Subtotal: $0.00
Enter Coupon
Total cost $0.00
9
Date
Date
Year
Month
Day
10
Time
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
Should be Empty: