First and Last Name *

 
Age: *

 
Phone Number / Skype username: *

 
Location (City, Country) *

 
Occupation: *

 
What does the next level of your life look like? In three months where do you want to be? *

 
What is the #1 challenge you have achieving your dreams? *

 
Are you willing to invest yourself emotionally, physically, and financially to achieve your dreams? *

 
Why do you want to work with ME (Cam) as your coach, friend, and mentor? *

 
Why should you be one of the people chosen to be on this life-changing journey? *

 
Approximate monthly income? (Private & Confidential - fee same for all participants) *

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