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* 1. What is your gender?

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* 2. What is your age?

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* 3. Education

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* 4. How did you hear about The Habit Factor?

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* 5. Have you read the book?

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* 6. email address please

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* 7. Name (first last)

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* 8. Have you written a review of THF?

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* 9. Do you use THF app?

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* 10. In what city do you live?

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* 11. What ONE thing are you most interested in The Habit Factor helping you to achieve?

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* 12. I am interested in participating in a Private Habit Factor Accountability Group (Facebook) as soon as possible please send me the short application (this is FREE)

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* 13. I am interested in participating with Martin in a Private MasterMind (Limited to a Group of about 8 People) / Coaching Call (Monthly) for min Six months!

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* 14. If YES... My interest would be in (specifically)

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* 15. I am interested in private weekly or bi-weekly accountability / coaching (private) (Minimum 6 months) and want to learn more...

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