Class Registration Survey

Evolve: The Mecca for Liberation, Transformation, and Connection

Welcome! I'm thrilled that you have taken the first step to achieving your goals. This short form will help me get to know you better prior to class!

Our online classes are offered several times throughout the year. Some are offered online and others in person during Weekend Retreats. To learn more about what's coming up, fill out this form and we will be in touch with details about upcoming classes. This form can also be used to register for an upcoming class that you are interested in.

Use this link to pay for your upcoming class. Once you have completed payment you will receive additional logistics about your upcoming class. *Please add @rebeccacooley.com and @evolvemecca.com to your address book.

I look forward to meeting you soon and helping you achieve your goals!

-Rebecca Cooley, Certified Master Coach & Instructor
Founder/CEO

*Master Coach Rebecca Cooley specializes in executive coaching, public speaking training, career transition services including interview preparation, and mindfulness.

1.Contact information(Required.)

Name:

Occupation and Title:

Age:

Address:

City:

State:

Phone Number:

Email Address:

Which class are you interested in? (please include the full name of the class AND the start date)

Would you like to receive more information about upcoming classes/newsletter?

2.What do you want to achieve through this class? What desired outcome do you hope to gain from this class?(Required.)

4.What is your biggest challenge? What do you most want to improve? (Required.)

5.What strategies have you taken so far to help yourself achieve your goals and address any challenges you are facing? (check all that apply)(Required.)

Classes

Individual or Group Counseling or Therapy

Independent Study

None of the above

Other (please specify)

6.How do you hold yourself accountable and motivated to achieve your goals?(Required.)

7.Are you taking this class online or in-person at our office in Cary, NC?(Note: Online classes are offered as pre-recorded lessons and posted in the private Facebook forum each week. You will have the opportunity to ask your questions each week and join us for weekly Live Q&A Sessions with Rebecca.)(Required.)

8.Which keywords did you use to search for us? (ex. Public Speaking Coach Raleigh, Executive Trainer Raleigh)(Required.)

9.Prior to submitting this form, please read the Coaching Agreement. You can also use this payment link to finalize your registration (due prior to the start of class).(Required.)

Yes, I have read and agree to the terms outlined in the Coaching Agreement

Yes, I understand that payment must be received prior to the class start date, to complete my class registration.