The Client Application
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This application is my pledge of commitment to successfully completing your apprentice program. As one of your 17 Dedicated Apprentices I'd like to bring Dreams Of Creating $100,000 To Fruition and get Private Access to communicate with this elite group supporting each other along the way.

Please let me know if I’m approved for the program as soon as possible.

The information below will be kept private and confidential so please be open and sincere with your answers. You are safe here.

All Fields Are Required
If you don't have an answer for a question,
please type "I don't know" or N/A

First and Last Name:
Company Name:
Address:
City/Town:
State/Province:
Country:
Phone:
Email:
Please describe the business you are currently in:
What, specifically, caused you to apply?
Why do you think you would be a good fit for the Assured Success LIfe Coach Program?
What is your current income situation?
How much time do you have available per week for developing your own business?
Why do you choose Assured Success Life Coach over other programs?
Why should YOU be chosen to be one of the 17 selected for the Dedicated Apprentice Program?
What else would you like us to know when considering you for this program?
If approved as a Dedicated Apprentice, how would you prefer to pay for the 8 month program - A - in full and save $1000 and get the reduced rate of $4500? (Answer yes or no.)
Or B - put some of the payment down and make 11 payments using the income developed as a result of applying the training with no interest and will full access to all components of the program? (Answer yes or no.)
Your Name:
Your Email: