Bali Mastermind

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
Why do you want to join this trip?* This field is required.Other than the obvious sun/beach connection.
Huge
Large
Normal
Small
Ok
Ok
5
Grade the following areas * This field is required.These are the major areas of our lives and areas we intent to enhance with each other at the retreat
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Professional & Business
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Health & Wellness
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Family & Relationship
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Financial & Income
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Social & Fun
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Professional & Business
Health & Wellness
Family & Relationship
Financial & Income
Social & Fun
Not Satisfied
Row 0, Column 0
Somewhat Satisfied
Row 0, Column 1
Satisfied
Row 0, Column 2
Very Satisfied
Row 0, Column 3
Not Satisfied
Row 1, Column 0
Somewhat Satisfied
Row 1, Column 1
Satisfied
Row 1, Column 2
Very Satisfied
Row 1, Column 3
Not Satisfied
Row 2, Column 0
Somewhat Satisfied
Row 2, Column 1
Satisfied
Row 2, Column 2
Very Satisfied
Row 2, Column 3
Not Satisfied
Row 3, Column 0
Somewhat Satisfied
Row 3, Column 1
Satisfied
Row 3, Column 2
Very Satisfied
Row 3, Column 3
Not Satisfied
Row 4, Column 0
Somewhat Satisfied
Row 4, Column 1
Satisfied
Row 4, Column 2
Very Satisfied
Row 4, Column 3
1 of 5
6
Tell us a little bit about your career or business?* This field is required.Business model, income levels, targets etc.
Huge
Large
Normal
Small
Ok
Ok
7
What are your passions and hobbies?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
8
What talents, expertise and skills do you possess that can edify our group?This trip is not just about what you can receive but also what you can share with others.
9
This will be an epic 5-star all inclusive event (ground transportation, entertainment, excursions, food, wine, liquor, luxury accommodations, chef, staff, and materials for the training are ALL INCLUDED) The investment for a seat at the Bali Mastermind is only $3,500, is that comfortable for you.* This field is required.*** AIR Fare is NOT included ***
YESNO
Should be Empty: