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Short Application

Quickly help us understand how this accountability group will benefit you and what you will bring to the group

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* 1. Name

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* 2. Email Address

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* 3. What is your gender?

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* 4. Age?

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* 5. I heard about The Habit Factor via

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* 6. I will bring..... to the accountability group

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* 7. I'm hoping to gain... from the accountability group

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* 8. My goals with The Habit Factor include...

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* 9. Twitter Handle:

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* 10. I would like to join the group

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* 11. I am interested in small group coaching with Martin OR, a THF Certified Coach specifically for

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* 12. I am currently using The Habit Factor app (ios or android) and tracking my habits

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* 13. I agree to the following "RULES". I understand that not following them may result in the termination of my membership privileges. Please check ALL to demonstrate agreement/understanding.

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