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RISE EVENT APPLICATION FORM
(Time Required 5-6 Minutes)
14
Questions
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1
Name:
*
This field is required.
First Name
Last Name
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2
Current Email:
*
This field is required.
(WE DO NOT SPAM)
example@example.com
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3
Cell/Mobile Number:
*
This field is required.
(THIS WILL BE THE PRIMARY FORM OF CONTACT WITH YOU-- ENSURE THIS IS ACCURATE!)
Please enter a valid phone number.
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4
Cell Phone Type:
iPhone
Android
Other
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5
Where do you reside currently (City & State)?
*
This field is required.
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6
Current age?
*
This field is required.
Please Select
Below 25
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
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50
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58
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60
61
62
63
64
65
Above 65
Please Select
Please Select
Below 25
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
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49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
Above 65
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7
Current age?
*
This field is required.
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8
Current fitness level?
*
This field is required.
POOR - MOBILITY ISSUES - CANT WORKOUT
BELOW AVERAGE - DONT WORKOUT
AVERAGE - WORKOUT OCCASSIONALLY
ABOVE AVERAGE - WORKOUT REGULARLY
ELITE - DAILY WORKOUTS
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9
Current relationship status?
*
This field is required.
Please Select
Single
Dating
Engaged
Married
Separated
Divorced
Widowed
Please Select
Please Select
Single
Dating
Engaged
Married
Separated
Divorced
Widowed
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10
Current relationship status?
*
This field is required.
(SINGLE, ENGAGED, MARRIED, DIVORCED, WIDOWED, ETC)
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11
Do you have any children?
*
This field is required.
YES
NO
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12
What is the biggest obstacle/challenge you are facing in your life right now?
*
This field is required.
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13
If you don't get past this obstacle, what will likely happen?
*
This field is required.
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14
When you consider your life as a whole and where you are right now; has it turned out the way you wanted?
Yes, 100%
Yes, for the most part
No, not entirely
No, not at all - it's all fucked right now
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15
Do you own a business currently?
*
This field is required.
(*This is not required to attend)
YES
NO
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16
Current profession / Business type?
*
This field is required.
(ie. JOB TITLE AND/OR PROFESSION)
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17
Current income level?
*
This field is required.
*If you are below $50,000/yr, consider the online RISE 300 Challenge instead: (
www.rise300challenge.com
)
Under $50,000 Annually
Under $80,000 Annually
Under $100,000 Annually
Under $125,000 Annually
Under $150,000 Annually
Under $200,000 Annually
Under $500,000 Annually
Greater than $500,000 Annually
Other
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18
Highest education level?
*
This field is required.
DID NOT GRADUATE HS
GED / HS DIPLOMA
TRADE SCHOOL / ASSOCIATES DEGREE
MILITARY SERVICE/CERTIFICATION, ETC.
BACHELORS DEGREE
MASTERS DEGREE
DOCTORATE
OTHER
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19
Have you attended any leadership training, endurance challenges, men's retreats, military service, etc. in the past?
YES
NO
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20
If you answered YES to the last question, briefly tell us about those experiences.
(If you answered NO, type NA)
*
This field is required.
(ie. Name of program/Topic/Year Attended, etc)
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21
Have you attended any leadership training, endurance challenges, retreats, or personal growth / development training in the past? (If so, which ones and when?)
*
This field is required.
(IF NONE, TYPE NONE)
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22
Have you been convicted of a felony?
*
This field is required.
(Failure to be truthful regarding this statement will immediately disqualify you from all RISE Events)
YES
NO
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23
If you answered YES to the last question, please share the circumstances and crime you were convicted of;
*
This field is required.
(If you answered NO, type "N/A")
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24
Due to the high number of applicants, we are selective when offering the opportunity to attend our events. Why should you be considered for a spot?
*
This field is required.
(This is your shot. It's recommended that you give this answer some effort)
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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25
RISE is a
90-Day Transformational Program
which includes:
60-day Online Lead-up
,
3-Day Live Event & 30-Days of post-event Coaching.
Are you ready to go "all-in" on discovering your greatest version?
*
This field is required.
YES
NO
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26
What are you most eager to gain as a result of attending RISE?
*
This field is required.
(YOU MAY CHOOSE MORE THAN ONE)
INSPIRATION & MOTIVATION
UNLOAD GUILT & SHAME
ACCOUNTABILITY & DISCIPLINE
HOPE FOR MYSELF AND MY FUTURE
BROTHERS & BROTHERHOOD
INCREASED BUSINESS & INCOME POTENTIAL
RECONNECT TO GOD/SPIRITUAL CONNECTION, ETC.
DISCONNECT & GET OFF GRID FOR A FEW DAYS
PUSH MYSELF PHYSICALLY & PSYCHOLOGICALLY
IMPROVE MY FITNESS
HIT SELF-DEFINED TARGETS
INCREASE MY CONFIDENCE
INCREASE MY CERTAINTY
IMPROVE MY MARRIAGE
IMPROVE MY RELATIONSHIP WITH MY KIDS
OTHER
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27
How did you find out about RISE?
*
This field is required.
FACEBOOK / FB AD
GOOGLE SEARCH
LINKEDIN
INSTAGRAM / IG AD
FAMILY / FRIEND / RELATIVE
RISE GRADUATE
OTHER
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28
After submitting this application, you will be forwarded to another page. Make sure you follow the instructions on that page to continue to be considered for RISE.
*
This field is required.
I understand & will follow the instructions on the next page.
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