Coach Training {Full Payment} - More to Be

Name: *
Email: *
Cell Phone:
Street Address:
ZIP Code:
Time Zone:
Please take a few minutes to complete this form as part of the registration process for the Coach Training Course hosted by More to Be, offering certification through Life Breakthrough Academy.

Full Name:
{"type":"text","name":"FullName","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"This is what will be printed on your certificate."}

{"type":"text","name":"CTemail","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}

Mailing Address:
{"type":"textarea","name":"CTmailingaddress","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"This is where we will send your certificate."}

What is your birthdate:
{"type":"text","name":"CTbirthdate","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}

Please let us know which course date you are registering for since we often have more than one going at a time:
{"type":"text","name":"cohort","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"Please indicate class start date, day of the week and time."}

Please let us know if you would like to pay in full or make three payments?
{"type":"radio","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please make a selection for this item.","options":"One payment of $798 US\nThree payments of $266 US"}

Please tell us a little about your background and life story.
{"type":"textarea","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"Be as detailed as you like."}

Please share why you are interested in taking this course and how you would like to use life coaching:
{"type":"textarea","name":"__generic2","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":"There's no right answer! We're just interested in how we can support you!"}

Is there anything about your life that you feel would be important for me to know? 
{"type":"textarea","name":"__generic3","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":""}

Do you agree with the Life Breakthrough Statement of Faith (
{"type":"radio","name":"__generic4","width":100,"value":"","size":"Small","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}

Do you agree with the Life Breakthrough Coaches Creed (
{"type":"radio","name":"__generic5","width":100,"value":"","size":"Small","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}

Do you agree with the Life Breakthrough Terms of Service (
{"type":"radio","name":"__generic6","width":100,"value":"","size":"Small","validation":"C1","validationMessage":"Please make a selection for this item.","options":"Yes\nNo"}

How did you hear about this opportunity?
MoreToBe.comMore to Be PodcastPinterestFacebookInstagramEventGirlfriendsInGod.comReferralOther{"type":"select","name":"__generic8","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"\nMore to Be Podcast\nPinterest\nFacebook\nInstagram\nEvent\\nReferral\nOther"}

Thanks for taking the time to complete this form. Upon receiving your payment, we will be in touch within two business days or less to give you course access.

Almost done! Please enter your payment information to complete your purchase.

You will be billed immediately $798.00.

Name on Card:
Card Number:
Expiration Date:
ZIP Code: