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
If you own a business, what is your average monthly revenue or If you are employed, what is your current annual income?* This field is required.Current Income Snapshot
5
Based on the plans you had for your life 5–10 years ago…* This field is required.
Yes, I’m exactly where I planned to be
Somewhat, but not fully
No, I’m far from where I expected to be
6
Without hesitation — do you feel your financial future is secure?* This field is required.
Absolutely
I hope so
No, and that worries me
7
How important is it for you to find real solutions to the financial challenges troubling you?* This field is required.
It’s a priority
It’s important but not urgent
I’m just exploring options
8
If you decided to change your financial trajectory, how soon are you looking for resolution?* This field is required.
Immediately
Within 2 weeks
Within 1 month
Within 3–6 months
Within a year
9
If you could design your ideal life and lifestyle over the next 3–5 years, what would it look like?* This field is required.
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10
Do you believe your current income reflects your true earning potential?* This field is required.
Yes
No, I know I should be earning more
I honestly don’t know
11
Do you believe your financial situation is:* This field is required.
Fully within your control
Somewhat within your control
Mostly outside your control
12
When you think about money, what emotion comes up most often?* This field is required.
Confidence
Stress
Frustration
Fear
Motivation
13
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
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14
If you could have the life/lifestyle you desired today, what would that look like for you?* This field is required.
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15
When it comes to investing in yourself financially, do you:* This field is required.
Act quickly when you see value
Need time to think
Often delay decisions
16
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)
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