Premier Business Coach For Entrepreneurs

TIME ZONE:

Virtual - Eastern

COACH:

Gina Pellegrini

ANNUAL FEE & DEPOSIT:

$10,000.00 USD
^{(including applicable taxes)}

$2,500.00 non-refundable deposit

Confidential Application Form

* Required Fields

First name: *

Last name: *

Common name:

Date of Birth: (format mm-dd-yyyy) *

Company name: *

Type of business: *

Billing Address

Business Address (Please no P.O. Box numbers): *

Country: *

City: *

Province / State: *

Postal Code / Zip Code: *

Business Phone: *

Cell Phone:

Home Phone (emergency use only):

Email Address: *

Confirm Email Address:*

Name on Credit Card: *

Credit Card Number: *

Credit Card Expiry Month / Year: *

Is there someone specific that referred you to us? If so, please provide their name(s):

Please list any professional/trade associations to which you belong, if any.

Name of Assistant or Key Administrative Staff:

Email Address (Assistant):

Phone/Extension (Assistant):

I certify that my personal income from entrepreneurial activities is: *
  Between $200,000 - $500,000
  $500,000 to $1,000,000
  More than $1 Million

Please include me in your mailing lists for marketing materials.

By signing up as a Strategic Coach^® client, you certify that you have read and agreed to Strategic Coach’s Privacy Policy and Terms and Conditions, and you understand that your acceptance and participation in the Strategic Coach^® Program is dependent upon a Right-Fit conversation with a Membership Advisor and verification of your qualifying entrepreneurial income level. You also understand that:

(i) the balance of your annual fee is due three weeks prior to the date of the first session, and if you register for the Program within three weeks of the first session, the full annual fee amount is due at the time of registration; and

(ii) your deposit is non-refundable or transferable; and

(iii) once you attend the first session, none of the annual fee is refundable or transferable, and there is no credit for missed sessions; and

(iv) Strategic Coach may contact me, electronically or otherwise, regarding my progress in the Program or to let me know about new products, services, and features offered by Strategic Coach.

I hereby authorize The Strategic Coach Inc./The Strategic Coach USA Inc./The Strategic Coach UK Ltd. to charge the credit card account number above for the deposit amount.**

I hereby authorize The Strategic Coach Inc./The Strategic Coach USA Inc./The Strategic Coach UK Ltd,. to charge the balance including applicable taxes, three weeks prior to the start date using the above credit card.

* Required field.

**Please note that your credit card will not be charged for the deposit until you have been verified by a Membership Advisor.

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TIME ZONE:

Virtual - Eastern

COACH:

Gina Pellegrini

ANNUAL FEE & DEPOSIT:

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TIME ZONE:

Virtual - Eastern

COACH:

Gina Pellegrini

Dates:

ANNUAL FEE & DEPOSIT:

Confidential Application Form