Phoenix Rise Application
Please complete this application as the first step of your registration.
Email address *
First Name *
Your answer
Last Name
Your answer
City/State/Country *
Your answer
Describe your current life situation and what it feels like. *
Your answer
Describe what you want your life to look and feel like? *
Your answer
What is your biggest obstacle to achieving the life you most want to be living? *
Your answer
What will you need to change for you to overcome this obstacle? *
Your answer
How will you use this program to change your life? *
Your answer
What are your top 3 strengths? *
Your answer
What are your top 3 challenges? *
Your answer
On a scale of 1-10, how willing are you to invest in yourself to create the life you want? *
I'm not willing.
I'm ready to do whatever it takes!
Name 3 of the biggest results you'd like to get from working with me. *
Your answer
What specifically draws you to work with me? *
Your answer
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