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28 Day Breakthrough! (Enrollment Wait List)
All parties who complete this page will be given a $50 credit /discount on the course enrollment!
Complete this survey for $50 Discount Off the already discounted $297 price!
1.
How did you hear of The Habit Factor®?
Book
App (Android or iOS)
Website
Habits 2 Goals, Podcast
Other (please specify)
2.
How might The 28 Day Breakthrough Course help/serve you?
To Kill My Limiting Beliefs
To become more productive and disciplined
To achieve my goals more quickly
To Kill My Fear of Failure
To Eliminate my Procrastination & Laziness
To Find my purpose in life
To Achieve Financial Freedom
To increase my confidence and self esteem
To Eliminate Depression
To enhance my GRIT / Resilience
To enhance my FOCUS
To enhance my Relationships
To enhance my Optimism/Enthusiasm
List specific comments, reasons here and be sure to convey goals/objectives.
3.
Best Contact Info Please to review
First
Last
Best Email
Best Phone: (If outside US, pls provide country calling code).
4.
How much time (PER WEEK) are you willing to invest in YOURSELF and this course --to participate provide feedback if requested?
.5 - 1Hr
1-2Hrs
2-3Hrs
3-4Hrs
Other (please specify)
5.
Would you be able to participate in a Facebook Private Group if necessary?
YES
NO
Other (please specify)
6.
On a scale of 1 - 10, How committed are you to personal development and making your desired goals a reality?
10
8 - 9
6 - 7
4 - 5
Less than a 4!
7.
What is your current occupation?
8.
Please add any additional comments or background you'd like to share. Thank you!
9.
Ideally, How quickly would you like to begin?
I'm ready to go now!
I can wait if needed
As soon as possible
I'm not quite ready yet but will be in a month or so
Probably in a few months
