VIP Registration Form

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. Cell Phone Preferred

Area Code

Phone Number

4

Based on how you planned your life out years ago, are you pleased with where you are today and know without a doubt that your future is financially secure?* This field is required.

Yes I Am Pleased. No Worries At All.

Somewhat Pleased But I Know I Should Be Doing Better

No I Am Not Pleased. I Should Be Much Further Ahead. I Feel Stuck!

5

What are the top 3 things that are troubling you financially and socially that bring you shame, guilt and disgust, that's keeping you up at night?* This field is required.Top 3 things about your life that trouble you the most that you definitely MUST change

6

How important is it for you to find solutions to these things that are troubling you?* This field is required.

Extremely Important

Somewhat Important

Not Very Important At All

Type option 4

7

How soon are you looking for a resolution?* This field is required.

Right Away

In 2 Weeks

In One Month

In One Year

8

If you could have the life/lifestyle you desired today, what would that look like for you?* This field is required.

9

What is your annual business revenue or your personal annual income?* This field is required.This question is asked to determine if working with our advanced services is in your best interest to move you towards your goals.

10

How Did You Learn About Us/Who Referred You?* This field is required.If referred by a person put their name in the space. Otherwise, add your source (email, facebook, TikTok, Instagram, etc)