Tiered Pricing Application

Full Name*

(First, Last)

Email*

(Please use the email that would be used for the program)

What is your combined annual household income?*

Are you...*

(Please check all that apply)

What would you like to accomplish in The Last 10 Program (Please be specific)*

What have you done already to work toward this goal or goals?*

How would this allow you to change your life?*

What tier pricing are you requesting?

*This should be the amount to make your participation in the program possible. The cost of The Last 10 program investment is $4,500. Tiered pricing available is either $3,500 or $2,500 based on your financial needs.

How would payments need to be structured for you to be able to contribute the remaining amount?*

Will you be able to participate in the program without a tiered pricing option? What would you need to do to make your participation possible?*

If accepted, are you FULLY committed to making a financial, emotional, and time commitment inside The Last 10 Program?*

If your application is accepted, you will be expected to fully participate in The Last 10 Program.*

Including: attending at least one coaching call each week, asking for coaching at least once per week, and completing The Last 10 curriculum (*the program requirements will be stated in detail in your client agreement)

Anything else you would like us to know?*