Step 1 of 2 50% Personal DiscoveryYour Money & You Instructor and our key support team read this information confidentially of course, to make sure they’re informed prior to the Program about specifically what you are committed to during the Program, prior to the Program attending. It is critical information for your Instructor to begin to get to know you and what you want to achieve. Please be sure to fill this out openly, honestly and with an intent to forward your Money & You experience for best results. Thanks in advance for doing so.Name* First Last Please upload your photo*Accepted file types: jpg, png, jpeg.Email* Enter Email Confirm Email Educational Experience*Please list any professional or advanced training you have had.Work Experience*Briefly describe your recent work experiences and areas of responsibility. Be specific. What do you consider to be your major career accomplishments?Personal Experience*List any special interest, growth, or personal activities, in which you are now or have been involved. (Self-awareness programs, meditation, physical activities, hobbies, etc.)Purpose*Clearly state your purpose and the specific results you intend to gain from participating in this program, and briefly state the area of business in which you intend to make a contribution.Goals and Objectives*List your business and personal goals for 3 months, 6 months, and one year from day of program.Additional Information*Is there any medical history that could in any way interfere with your full participation in program activities (such as late evening sessions)? If so, please state what that is.Current Annual Income*Please let us know your current income range for the purposes of understanding you likely current position around money and finances.Under $30,000$30,000-$50,000$50,000-$100,000$100,000-$200,000$200,000-$500,000Over $500,000Business Profile*Please tick all those options most applicable to you below.EmployeeBusiness OwnerEntrepreneurSelf-EmployedInvestorRetiredLooking for a new Business/ProjectStudentReady for ExitStart Up About Your HealthAre you under the care of a Physician or a Psychiatrist?*YesNoIf Yes, for what condition?*Have you ever been hospitalised in an institution for any reason?*YesNoAre you receiving medication?*YesNoIf yes, please list medication.*Have you had any history of heart trouble, rheumatic fever, diabetes, asthma, kidney or liver involvement, epilepsy, bleeding disorder, or brain injury?*YesNoIf yes, please tick the condition.* Heart trouble Rheumatic fever Diabetes Asthma Kidney or liver involvement Epilepsy Bleeding disorder Brain injury Are you allergic to any food or medicine?*YesNoIf yes, please list allergy.*Have you had surgery within the last year?*YesNoHave you had any serious illness or surgeries not listed that we should know about?*YesNoIf yes, please list.*Is there any reason or physical condition that would keep you from participating in any late evening session?*YesNoIf yes, please explain.*Contact In Case Of EmergencyName*Relationship*Phone* This iframe contains the logic required to handle Ajax powered Gravity Forms.
