Secure Partner Coaching Registration Prequalification for Secure Partner Coaching * I am NOT in marriage counseling * I am NOT in treatment for drug or alcohol abuse * I understand this package focuses on self-improvement rather than reconcilingCONTACT INFORMATIONName * Name First First Last Last Email * Town/City * State/Province * Country * Are you eligible for the 10% USA police/military rebate? Yes No For USA Military or Police: Upload proof of service for your 10% rebate * Drop a file here or click to upload Choose File Maximum upload size: 5MBCOACHING PREFERENCESPreference for Coaching Sessions * Phone Skype Zoom Phone Number * Skype Address * Email where you want the Zoom link sent * If your package is eligible for summaries or recordings, which do you prefer? * Bullet Point Summaries Mp3 RecordingsPreferred Coaching Time * Morning Afternoon Evening Anytime Specific days and times only... Specify availability for your time zone * Living Situation * Single Married and living with spouse Married and NOT living with Spouse Brief description of why you are seeking coaching * * I consent to the terms of the Coaching Agreement. If you are human, leave this field blank. Go to Package Options
