If we keep doing the same thing, we'll get the same results. If we keep doing the same thing, we'll get the same results. If we keep doing the same thing, we'll get the same results. Name * First Name Last Name What are your health and fitness goals? * What would you say is the biggest obstacle holding you back from the body and health you desire? * What do you feel you need from a program/coach to reach your health goals? * Have you invested in your health, appearance, or personal growth before? * select one I have invested in my health significantly I have invested in my appearance significantly (clothes, accessories, etc) I have invested in my personal growth (books, conferences, mentors, etc) I have invested in one or MORE of the above I have never invested in myself before Briefly describe where you are at with your body: What's your age, height, weight and pant size? * On a scale from 1-10, how important is it for you to achieve your goals NOW as opposed to putting them off? * 1 being of least importance, 10 being of most importance 1 2 3 4 5 6 7 8 9 10 How soon can you get started? * Why should you be selected to join the Empower Coaching Academy? * Email * Phone * Country (###) ### #### Thank you!
