SMG Membership Application
Email address *
Name *
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Phone Number *
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Date of Birth *
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1. What are the top 3 things you would like to create in your life within the next year? *
Your answer
2. What is the calling deep within you? *
Your answer
3. What contribution do you want to make? (to family, community, the world, your clients?) *
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4. What experiences do you still want to have in the following areas of your life? Career, Home, Love, Family, Travel, Events, and Possessions. *
Your answer
5. What challenges are you facing as you attempt to create the life you want? *
Your answer
6. What are these challenges (from #5) costing you? (Money? Peace? Taking action? Love?) *
Your answer
7. Are you currently working with any therapists, healers or coaches? If so, what are they specifically helping you with? *
Your answer
8. What do you believe is the missing piece in your life right now? *
Your answer
9. Which negative patterns are showing up in your career and financial life? *
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10. How are these negative patterns (from #9) affecting other areas of your life? (Love, body, friends?) *
Your answer
11. If you are taking any medications, please list them here: *
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12. How committed are you to having the life you desire? *
I agree that I have read the agreements and legal pages described on the Sandpoint Men’s Group website and I agree to abide by those agreements if I become a member. *
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A copy of your responses will be emailed to the address you provided.
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