JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Victorious Living 12-Week Personal Transformation August 1-October 17th 2024
Registration Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name
*
Your answer
Address
Your answer
Phone number
*
Your answer
Date of Birth
*
Your answer
What are your intentions during our 12 week personal transformation journey?
Check all that apply
Renewed Confidence
Healing from grief
Healing from a broken heart
To discover my purpose
Reignite my dreams
Physical healing
Financial healing
Peace of mind
Spiritual healing
Personal Development
Other____________________________
Check all that apply
Renewed Confidence
Healing from grief
Healing from a broken heart
To discover my purpose
Reignite my dreams
Physical healing
Financial healing
Peace of mind
Spiritual healing
Personal Development
Other____________________________
Congratulations on taking this step to transforming your life! Save $100 if full payment is made by July 15th, 2024. Make payment to: Windward Island Bank US Bank
Account: 21552202; Swift Code: WISBSXSM or Windward Island Bank NAF Account: 21424300
*
Choose
Payment option 1. On or before July 15th $400
Payment option 2. Pay $500 after July 15th, payment deadline: July 25th
Payment option 3. 6 installments of $100.00 each, starting on or before July 25th
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
