Short Application

Quickly help us understand how this accountability group will benefit you and what you will bring to the group

* 1. Name

* 2. Email Address

* 3. What is your gender?

* 4. Age?

* 5. I heard about The Habit Factor via

* 6. I will bring..... to the accountability group

* 7. I'm hoping to gain... from the accountability group

* 8. My goals with The Habit Factor include...

* 9. Twitter Handle:

* 10. I would like to join the group

* 11. I am interested in small group coaching with Martin OR, a THF Certified Coach specifically for

* 12. I am currently using The Habit Factor app (ios or android) and tracking my habits

* 13. I agree to the following "RULES". I understand that not following them may result in the termination of my membership privileges. Please check ALL to demonstrate agreement/understanding.