MindStory Academy

First Name*

First

Last Name*

Last

Email*

Best "Contact" Phone Number

Call Preference*

Phone
Skype or Zoom with Video
Skype or Zoom Audio Only

Time Zone*

Links to any relevant websites or social media pages

How did you hear about this opportunity for training/coaching? (Check All That Apply)*

I'm on email list
Search Engine
Advertisement
Referred by a Friend / Colleague
Heard about it on Podcast or Webinar
Other

If referred, who do we thank?

Tell us briefly about your business or role in life right now*

What market do you serve? I.E. Who is your customer, company, or who do you want to serve?

If you have a business, how much do you charge for your products and services (or what is the range)?

What currency do you mostly earn your income in?*

US Dollars
British Pounds
Euros
Canadian Dollars
Australian Dollars
Other

What is your general yearly income from all sources?*

Less than 10K per year
11K to 50K per year
51K to 80K per year
81K to 100K per year
101K to 200K per year
201K to 500K per year
501K to 999K per year
More than 1 million per year

If we both feel it's a good fit for you to participate, do you have the funds available for professional development like this?*

Yes
No
I'm not sure. I need to research funding sources.

Be totally open with your answer. . . what do you think is stopping you from success right now? . . . The more specific you are here the better.*

What makes you believe you could be successful? What do you have going for you in terms of skills, experience, support, resources, vision, passion etc?**

If we both agree it's a good fit, are you willing to fully commit to the process and give it your absolute best?*

Yes
No
I'll try