EA Lewis Applied Coaching Academy Application

Thank you for your inquiry. Please complete the following…

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Check the program you are applying to:

• Coaching Excellence Program
• Coaching Mastery Program

Name

First

Last

Business Name

Business Address

How Did You Hear About Us

Website

LinkedIn

Email

Cell Number

Number of Years Coaching

Why Do You Want to build Your Coaching Practice?

Describe your Coaching Knowledge and Experience

Describe Your Work Ethic and Attitude

Describe Your Top Three Goals (copy)

What Are Your Biggest Roadblocks?

I Agree to Pay – Card is Charged Only After the Intro Call and Application is Accepted. – Choose One

• Level 1. Coaching Excellence Program: $1,500/lesson for 10 lessons, plus a $500 Start-up Fee.
• Level 1. Coaching Excellence Program: $13,500 Paid in Full
• Level 2. Coaching Mastery Program – Eligibility TBD after Intro Call

I Agree

• Refund Policy: All Paid Fees are Non-refundable.; if inside 30 days, $500 is non-refundable. Accounts paid in full and in advance will be prorated accordingly.

Payment Info – Card is Charged Only After the Intro Call.

• Visa
• Mastercard
• Amex

Name on the Card

CC Number

Exp Date

CVV

Billing Address

Your (copy) I

Intro Call Availability in the next 1-3 days?

Preferred Contact Method

• Call
• Text
• Email

Signature (Type Your Full Name)

Submit