First and Last Name *

Business Name / What You Do *

What is your website (or preferred social site if you don't have a website) *

For which program are you applying *

Why are you applying; what do you hope to get from this 3-month program? *

Is there anything else you want me to know? *

If selected for the program, will you commit to fully participating? *

50% payment for the group or 1:1 programs must be remitted (via Paypal) within 2 weeks of acceptance. Do you agree to these terms?

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