Coaching Application

Name *

First

Last

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone Number *

Website / URL *

Facebook Profile Link (for business) *

Instagram Profile Link (for business)

Do you have a certification? *

List your certifications *

How many years have you been coaching? *

Do you carry liability insurance? *

Please indicate what coverages you carry? *

Do you carry limits of $1 million? *

Are you willing to increase your limits to $1 million? *

Are you willing to name Live Free Ministries as an add'l insured on your policy(ies) *

What type of coaching services do you offer? *

Describe your coaching program and any materials/curriculums you use. *

What best describes your coaching practice? *

What are the price points of your services? *

Reference Name #1 *

First

Last

Reference Email #1 *

Reference Name #2 *

First

Last

Reference Email #2 *

Please confirm that you are giving us permission to contact these references: *

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