FILL OUT THIS APPLICATION TO BEGIN

Name

First Name

Last Name

What are your pronouns?

She/her

He/him

They/them

Where do you live? i.e. city and country

If successful, how will you be choosing to value this experience? It's important you are able to value this energetic exchange.

Full payment upfront ($1,200NZD)

2 x monthly payments ($600NZD x 2)

4 x monthly payments ($300NZD x 4)

Other

What current blocks are coming up for you? What are you currently struggling with?

What is drawing you to this experience? Why do you want to work with me?

What kind of personal growth and development have you done before? Who have you worked with?

What does it mean for you to fully show up for yourself in this experience? What are you willing to put into this experience?

Are you currently or have you in the past experienced any serious mental or physical illnesses? If so, please detail below.

Do you agree to take 100% personal responsibility for your own growth and development within this container?

This includes your financial commitment and all payments.

Yes