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First Name (as you wish to be called)
Mobile Phone Number (we need this in case we have to text you about class info)
Are you an active member of The EGO Tamer® Academy?
In which coaching program are you enrolled at The EGO Tamer® Academy?
What is the end date for your coaching program?
Are you a business owner?
Please indicate which type of business you own.
If you selected "Other" above, please let us know what type of business you own.
What is the address for your website? (If you have more than one, please separate them with a comma.)
Do you have a Facebook Fan Page/Business Page?
What is the address for your Facebook Fan Page/Business Page? (If you have more than one, please separate them with a comma.)
Please briefly describe what your primary business goal is for the next 12 months?
Are you interested in certification as a Facilitator/Coach for The Resiliency Course?
Upon submitting this enrollment application, you'll be automatically directed to The Resiliency Course's Grief Inventory and Personalized Stress Assessment
CONFIDENTIALITY AND NON-COMPETE: The Resiliency Course is a service of Jan Luther and The Rejuvenation Station, LLC. By submitting this form, you are indicating that you understand that the tools, stories, concepts, strategies, materials and information presented by Jan Luther and The Resiliency Course are confidential, copyrighted and proprietary to Jan Luther and The Resiliency Course and agree not to record, duplicate, distribute, teach or train from The Resiliency Course materials and information in any manner whatsoever without the express written permission of Jan Luther and The Rejuvenation Station, LLC. Any unauthorized use or distribution of these proprietary concepts, materials and intellectual property by you or your representatives is strictly and legally prohibited. Jan Luther and The Rejuvenation Station, LLC will pursue legal action and full damages if these terms are violated in order to protect its rights.
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