Integrated Man Coaching Group Application

Application for The Integrated Man Coaching Group

Thank you for taking the time to fill out all the answers.

Name *

First Name Last Name

E-mail *

Mobile Phone Number *

- Area Code Phone Number

Home Phone Number

- Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

What are 3 goals you would like to accomplish?

Goal #1 *

Goal #2 *

Goal #3 *

Have you taken the Behaviours & Motivators Survey? *

YES NO

If you clicked NO, please fill out the Behavioral & Motivators survey.

1) To begin the process: go to ttisurvey.com, enter 190528CUM and complete as per instructions.

2) Once completed, we will both receive the results via email.

The 3 Month Integrated Man Coaching Group includes:

Two 90-minute online group coaching sessions per month
One 15-minute private laser coaching session per month
FaceBook group for ongoing support
Unlimited email support
Structured activities including between-session assignments

There are two payment options. You can either pay $450 in full prior to the 1st session or $160 per month, the first payment prior to the 1st session. Please contact me at jim@coachjimparker.com to receive the paypal link. Thank you!