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

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!