Apply for Online Mentoring Circle Membership

DEADLINE TO APPLY:
Please Contact Susan if you are interested.

CST Mentoring Circles

Tuesdays, 2:00-3:30pm EST or 7-8:30pm EST

SER Mentoring Circles

Thursdays, 2:00-3:30pm EST or 7-8:30pm EST

Laser Coaching session times will be decided at a later date.

To apply please complete this application, including your goals, questions and preference of Mentoring Circle and time. Please check all group times that you can attend. After receiving your application, we will respond and invite you to join the circle that best meets your needs. Learn more about our online mentoring circles here >>

The entire 3-month program is $225.
Once your form is submitted and approved, you will be able to buy your 3-month membership.

Name*
First Last
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Goals to Accomplish*
- TECHNIQUES CERTIFICATION
- DIPLOMATE CERTIFICATION
- OTHER
Other Goals:
Upledger Classes Completed*
- CS1
- CS2
- SER1
- SER2
- ADVANCED 1
- ADVANCED 2
- TECHNIQUES CERTIFICATION
- DIPLOMATE CERTIFICATION
- OTHER
Other Classes:
Mentor Dates you are available
Additional Comments
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