COACH SMITH

30 MIN CLARITY CALL

If you’re ready to get better in Faith, Family, Fitness, and Freedom, complete this application fully and honestly.

This is not for everyone.

Applications are personally reviewed.

If approved, you will receive a text to schedule a 30-minute Clarity Call with Coach Smith.

Full Name *

Phone *

Email *

City *

State *

Confirm Timezone *

Occupation / Industry *

Best Time To Call *

Morning

Lunch Break

Evening

Weekends

Relationship Status *

Married

Engaged

Single

Divorced

Widowed/Widower

Which area needs the most attention right now? *

Faith

Family

Fitness

Financial / Business

Discipline & Consistency

On a scale of 1–7, how aligned do you feel right now in your life? *

1 - Low & 7 - high

Why do you believe you need a coach right now? *

What has not been working for you? *

Are you prepared to invest in your growth if accepted? *

Yes — $3,000 paid in full
Yes — $1,200/month (3-month minimum)
I need to start with the $1,000 automated program
Not sure yet
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If approved, are you prepared to begin immediately? *

Yes
No
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This program requires discipline and consistency. Are you willing to fully commit for 90 days? *

YES
NO
Option 3
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By checking this box, I consent to receive non-marketing text messages from Brian Smith about coaching. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive marketing and promotional messages including special offers, discounts, new product updates among others from Brian Smith at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.