IMPORTANT:  Please only apply below if you have taken the time to read the information on the previous page which outlines:

  • Exactly what you will receive as Premium Web-based Coaching client (more than $1400 in total value for less than the cost of working with an average, local personal trainer)
  • The difference between Basic and GOLD client status (GOLD clients receive priority email support and access to me along with several other valuable bonuses that basic clients do not)
  • The cost of the program (Basic entry is currently $174/month with a $99 start up fee; GOLD is $197/month with no sign up fee; see current month's special below)
  • Our 100% Risk-Free Money-Back Guarantee (Simply put, your satisfaction is 100% guaranteed; we promise to blow away your expectations or your money back, no questions asked)

More information on all of these items is available on the program description page that brought you to this application.

That said, if you are familiar with the program and are ready to make one of the best decisions you will ever make for your body and health, get started today by filling out the brief application below.

SPECIAL PROMOTION - THIS MONTH ONLY:  We are currently running a special that makes the GOLD upgrade FREE as anyone who signs up to become a GOLD client (and is accepted into the program) this month will have the
$99 start-up fee waived.  This is a tremendous value in and of itself as GOLD clients get priority email access and support directly from me, and when you sign up today, you get it FREE.

Premium Web-based Coaching Application Form  

Because the Premium Web-based Coaching Program is an exclusive service limited to a select few individuals at any given time, all potential clients must complete the below application as part of our screening process.  Once your application has been received, I will personally respond with my thoughts and current availability (generally within 24-48 hours).

Questions regarding your current exercise habits and fitness level are for informational purposes only and do not affect the outcome of your application.

With that said, please fill out all fields and answer all questions as accurately as possible (all fields must be filled out in order to submit this form).

Full name
Email Address
Confirm Email Address
Day Phone
Body Fat% (if known)  

1. How did you find out about the Coaching Program?

2. Are you applying for Basic or Gold client status?

3. Briefly describe your specific, short-term goals (within the next 16 weeks) with regards to your body and health.

4. Briefly describe your specific, long-term goals (beyond 16 weeks) with regards to your body and health

5. Have you been diagnosed with any health conditions and/or are you currently taking any medications that I should be aware of? If so, please list and explain.

6. If you answered no above, simply type N/A in the box below. If you answered yes, do you have clearance from your physician to participate in a regular exercise program?

7. Are you currently exercising at least three times weekly? If yes, how long have you been consistently doing so?

8. If you answered yes above, simply type N/A in the box below. If you answered no, when was the last time you participated in regular exercise? How long did you participate in the program consistently?

9. How would you rate your current level of fitness? Poor, Fair, Average, Good, or Excellent?

10. Why do you want to be part of the Premium Web-based Coaching program at this time?

11. How important do you feel personal mentoring is to achieving your health and fitness goals? Not Important, Somewhat Important, Very Important?

12. Are you 100% willing to commit your FULL effort to this coaching program over the next 16 weeks?

13. Why do you believe that you will be successful at implementing your programming consistently?

14. Please use the box below for any additional comments.

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