28 Day Breakthrough! (Enrollment Wait List)

All parties who complete this page will be given a $50 credit /discount on the course enrollment!

Complete this survey for $50 Discount Off the already discounted $297 price!

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* 1. How did you hear of The Habit Factor®?

Book

App (Android or iOS)

Website

Habits 2 Goals, Podcast

Other (please specify)

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* 2. How might The 28 Day Breakthrough Course help/serve you?

To Kill My Limiting Beliefs

To become more productive and disciplined

To achieve my goals more quickly

To Kill My Fear of Failure

To Eliminate my Procrastination & Laziness

To Find my purpose in life

To Achieve Financial Freedom

To increase my confidence and self esteem

To Eliminate Depression

To enhance my GRIT / Resilience

To enhance my FOCUS

To enhance my Relationships

To enhance my Optimism/Enthusiasm

List specific comments, reasons here and be sure to convey goals/objectives.

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* 3. Best Contact Info Please to review

First

Last

Best Email

Best Phone: (If outside US, pls provide country calling code).

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* 4. How much time (PER WEEK) are you willing to invest in YOURSELF and this course --to participate provide feedback if requested?

.5 - 1Hr

1-2Hrs

2-3Hrs

3-4Hrs

Other (please specify)

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* 5. Would you be able to participate in a Facebook Private Group if necessary?

YES

Other (please specify)

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* 6. On a scale of 1 - 10, How committed are you to personal development and making your desired goals a reality?

8 - 9

6 - 7

4 - 5

Less than a 4!

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* 7. What is your current occupation?

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* 8. Please add any additional comments or background you'd like to share. Thank you!

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* 9. Ideally, How quickly would you like to begin?

I'm ready to go now!

I can wait if needed

As soon as possible

I'm not quite ready yet but will be in a month or so

Probably in a few months