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Pole Mentorship Program
Please take a moment to share a bit about yourself and your desires. Once I receive the form, I’ll reach out to you via email to schedule a short consultation call.
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Name + pole IG (if you have) *
Email *
Are you interested in including a personalized flexibility program to your mentorship (this will affect the pricing of your program)? *
How long are you interested in working together? (payment plans are available) *
What would you like to focus on? *
Required
How long have you been dancing? What are your goals? *
How can I best support your current practice?
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