We are not currently taking more members. TO GET ON THE WAITING LIST.. Please complete below. Thank you!

The Habit Factor Accountability Group on Facebook (yes, you need to have a Facebook account to join ; )

Short Application

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

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1. Name

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2. Email Address (Required.)

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3. What is your gender?

Female

Male

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4. Age?

55-65

45-55

35-45

25-35

Other (please specify)

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5. I heard about The Habit Factor via

Amazon: Read The Book (kindle, paperback, hardcover)

The "Habits 2 Goals" Podcast

The App (Android, iOS Free or Paid)

Friend

ITunes

The Pressure Paradox

I downloaded the Free Tracking Template

I am an AUTOBOT /crawler (an automated survey response machine) and you can and should DELETE this response!!

Other (please specify)

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

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

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

Make Money

Improve My Business

Lose Weight

Focus / Discipline

Improve relationships

Write a Book

Run a Marathon

I am an AUTOBOT /crawler (an automated survey response machine) and you can and should DELETE this response!!

Other (please specify)

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9. Twitter Handle:

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10. I would like to join the group

ASAP (as soon as possible)

Next Month

Next Year

If FULL - Please put me on the waiting list

Other (please specify)

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

My Business

Personal Growth

If FULL - Please put me on the waiting list

Other (please specify)

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

Yes!

Not yet.

Plan to - still learning how to use and track

I am tracking using The Habit Factor Free Template that I downloaded

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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.

I will be an active and engaged participant!

I will be a positive and encouraging participant!

I will only share personal experiences and will not give advice to group members

I will post my tracking charts weekly

I understand that if I miss TWO weeks in a row I may be "escorted" out of the group ; ) . Yes! We want engaged, trackers!

I understand this is not a substitute for personal coaching

I recognize Martin or his associates may not always be able to address any/all questions but will do their best

I accept that if I do not participate according to the above "rules" may be escorted out of the group. I know this is a volunteer/free group and also accept that it may cease at any time with or without notice.

I am an AUTOBOT /crawler (an automated survey response machine) and you can and should DELETE this response!!

Type your name/ signature here:

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* 1. Name

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* 2. Email Address (Required.)

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* 3. What is your gender?

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* 4. Age?

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* 5. I heard about The Habit Factor via

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

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

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

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* 9. Twitter Handle:

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* 10. I would like to join the group

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

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

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* 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.

1. Name

2. Email Address (Required.)

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.