Work With Madelaine Application Form

Apply to have Madelaine as your coach.

Hi there! I INVITE YOU TO FILL IN THE FORM BELOW SO THAT WE CAN CONNECT AND EXPLORE HOW I CAN HELP YOU IN YOUR LIFE. Please write and tell me a bit about yourself, why you would like to work with me and how I can support you. I am looking forward to connecting with you. Love, Madelaine.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail
Which if these categories suit you most?

ArtistEntrepreneur/ Business OwnerHealing and/or Personal Growth SeekerOther

Which area resonates most with you?

The Artist's Journey – I'm an artist looking to elevate my craft and overcome creative blocks.The Inner Journey – I'm looking for therapeutic help to heal and grow.The Creative Advantage – I'm a business owner or entrepreneur looking to harness my creativity to innovate and grow your business.Not sure yet, need guidance.
What's your yearly income?
Are you satisfied with the income you are making right now? Why, or why not?
What are 3 achievements you are really proud of?
Tell us about 3 events that have deeply impacted your life.

Would you consider yourself living on purpose? Why, or why not?
What is the one thing that if you changed it, it would have a massive, positive impact on your life?
If you could create anything, what would you create?

Apply to have Madelaine as your coach.