1. First Name 2. Last Name 3. Company 4. Job Title 5. I am seeking Personal Coaching Professional Coaching Personal & Professional Coaching 6. Country Albania Algeria American Samoa Andorra Anguilla Antigua & Barbuda Argentina Aruba Australia Austria Azores Bahamas Bahrain Bangladesh Barbados Belgium Belize Belarus Benin Bermuda Bolivia Bonaire Bosnia Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Islands Cayman Islands Central African Republic Chad Channel Islands Chile China – Peoples Republic of Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equitorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Holland Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Moldova Monaco Montserrat Morocco Mozambique Myanmar Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Ponape Portugal Puerto Rico Qatar Republic of Ireland Republic of Yemen Reunion Romania Rota Russia Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands South Africa South Korea Spain Sri Lanka St. Barthelemy St. Christopher St. Croix St. Eustatius St. John St. Kitts & Nevis St. Lucia St. Maarten St. Martin St. Thomas St. Vincent & the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tonga Tortola Trinidad & Tobago Truk Tunisia Turkey Turks & Caicos Islands Tuvalu Uganda Ukraine Union Island United Arab Emirates UnitedKingdom United States Uruguay US Virgin Islands Uzbekistan Vanuatu Venezuela Vietnam Virgin Gorda Wake Island Wales Wallis & Futuna Islands Western Samoa Yap Yugoslavia Zaire Zambia Zimbabwe 7. Address 8. Zip 9. Email 10. Alternate Email 11. Phone Number 12. Cell Phone 13. Skype 14. Urgency of Coaching Extremely Urgent Urgent Moderate 15. What are the Best Times to Call you? Afternoon Late Afternoon Evening 16. What Timezone are you in? 17. Would you like a Complimentary Session? Yes No 18. Refferred By Friend or Colleague Author’s Book Website 19. Other 20. Individual Name 21. Special Comments 22. Forms of Payment Paypal Credit Card Check Electronic Transfer

COACHING EXPECTATIONS Please share important facts about your personal background that will help me understand who you are. 1. What are your Top 5 Accomplishments? 2. What do you believe are your strengths or weaknesses? 3. When you think about the “big picture of life,” what would you say is the most important thing you want? 4. What is the most important step you can take this week to accomplish your “big picture” goals? 5. What are 3 short term goals that you want to achieve over the next 90-120 days? 6. What gives you energy, satisfaction, and joy? 7. What drains your energy? What keeps you awake at night or consumes time that you wish to eliminate? 8. How have you been motivated in the past to reach difficult goals or make difficult decisions? 9. Why have you hired me? What changes/benefits do you want from our coaching process? 10. How will you know that the coaching process is working?

Tags: netherlands antilles, new caledonia, republic of colombia, ivory coast, federated states of micronesia

Tags: antigua barbuda, barbuda argentina, burkina faso, cape verde islands, equitorial guinea, faeroe islands, federated states of micronesia, french polynesia, guiana french, guinea bissau, ivory coast, netherlands antilles, new caledonia, northern mariana islands, papua new guinea, republic of colombia, republic of yemen

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