STAR Membership Application

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We are using this form to learn if this opportunity is a fit for you and for us.

𝗥𝗘𝗤𝗨𝗜𝗥𝗘𝗠𝗘𝗡𝗧: 1 standard appointment for six consecutive months. If you'd like more appointments each month, no problem! While you are a member, each standard appointment is just $50. Note: Membership appointments are for you and cannot be transferred. If an appointment is missed, it will be forfeited.

𝗣𝗔𝗬𝗠𝗘𝗡𝗧: The first charge will be processed on the day of your first appointment. From that point forward, an automatic payment of $50 will be charged on the 1st of each month unless other agreements are made. If additional appointments are scheduled within the month, each appointment will be processed on the day of the appointment.

𝗕𝗢𝗡𝗨𝗦: Join the "Tune In Group" (in my personal online classroom) and have continued tools and community support during your membership.

Name *

Email *

Street Address *

City *

State *

Zip Code *

Phone number *

When is the best time to call? | Note your time zone. *

What describes you? *

I am looking for something or someone to fix me.

I am looking for healing.

I am feeling stuck in a rut and am looking for insight.

I am looking for the road map to achieve my goal.

I am looking to connect with loved ones who have passed on.

I am waking up and I have no clue what is next.

I am awake and I have MANY options for what is next.

I am awake and I have a good idea of where I am going next.

I am looking for guidance in my personal life.

I am looking for guidance in my professional life.

I am looking to learn.

I am looking for community.

I am looking for support.

I am looking for a mentor.

Other:

Required

Expand on what you are looking for ... *

How much time are you willing to set aside to reach the outcome you desire? *

< 20 minutes each week

20 - 60 minutes each week

60+ minutes each week

Whatever it takes!

Other:

Required

What would stop you from fully committing to achieving your outcome? *

The way I learn best is ... *

See: I learn by observing things like images, diagrams, etc. Example: Handouts and Videos

Hear: I learn by listening. Example: Podcasts

Verbal: I learn by written words. Example: Video, Audio, and Worksheets

Kinesthetic: I learn by hands on practice.

Social: I learn by doing things in a group setting.

Self Paced & Independent: I learn by doing things on my own at my own pace.

Other:

Required

Do you agree with the following 𝗥𝗘𝗤𝗨𝗜𝗥𝗘𝗠𝗘𝗡𝗧: Scheduling one standard appointment for six consecutive months. If you'd like more appointments each month, no problem! While you are a member, each standard appointment is just $50. Note: Membership appointments are for you and cannot be transferred. If an appointment is missed, it will be forfeited. *

Yes

Do you agree with the following: 𝗣𝗔𝗬𝗠𝗘𝗡𝗧: The first charge will be processed on the day of your first appointment. From that point forward, an automatic payment of $50 will be charged on the 1st of each month unless other agreements are made. If additional appointments are scheduled within the month, each appointment will be processed on the day of the appointment. *

Yes

Would you like to take part in this 𝗕𝗢𝗡𝗨𝗦: Join the "Tune In Group" (in my personal online classroom) and have continued tools and community support during your membership. *

Yes

Any additional thoughts, comments, fears, or wins ... feel free to share. 😊

Interview Notes, Agreements, Etc. (for office use only)

Submit

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