Name *

First Name

Last Name

Phone *

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What would your best friend say you are the MOST? *

Driven and Direct.

Steady, "Better safe than sorry."

Accurate, Detail Oriented, Dislikes Risk.

A People-Person, Talkative

Check the following boxes that apply to you. *

I am a solopreneur.

I am an entrepreneur.

I am a spouse.

I am a small business owner.

I am an executive.

I am a coach.

I am an athlete.

I am a partner.

I desire to experience freedom.

I want to be seen.

I want deep connection.

I am artful.

I am a dreamer.

I am authentic.

I want to perform with ease in all conditions.

I act with integrity.

I want to relesese stress and overwhelm with emotional release.

I am responsible.

I am collaborative.

I desire meaningful relationships.

I am focused.

I am determined.

I am a lover.

I desire greater intimacy.

I want to release fear with breathwork.

I am insightful.

I am an innovator.

I want to communicate with confidence & clarity.

I want support.

I am a giver.

I desire to be fully expressed in mind and body.

I am intuitive.

I am abundance minded.

What level of service are you most interested in? *

"Activation Release" - A 120 Minute Experience (starting at $1,000)

"The Break Free Sessions" - 5 Sessions over 30 days (starting at $5,000)

"The Remembering" - 3 Months Private Mentoring (starting at $15,000)

"The Provocateur" - 6 Months Private Mentoring (starting at $30,000)

"The Artist"- 12 Months Private Mentorship (starting at $100,000 by invitation Only)

"The Activation Experience" - One & Two Day VIP Experience (Starting at $25,000)

"The Lovers" - For Couples in Partnership (Starting at $50,000)