Application of AcceptanceComplete each of the questions below and return this application Name (required) Business Name (required) Street Address City/Town State Zip Code Phone Cell Phone Fax Email (required) Website **(Please note ALL information is kept completely Confidential)** 1. How Much Money Would You Want to Make in the Next Twelve Months? Less than $100,000$100,000-$250,000$250,000-$500,000$500,000-$750,000$750,000-$1,000,00$1,000,00+ 2. How Many Hours Do You Currently work Per week? 40+30-4020-3020-10less than 10Being completely honest with yourself, do you know you are working a little harder than you would like to?YesNo3. How Many Vacations Do You Currently Take Each Year? 0-33+4. How Many Vacations Would You LIKE to Take Each Year? 1-33+ 5. Please describe your business as it is right now. 6. If you could wave a magic wand and change 3 things in your business or life right now,what would they be? 7. Briefly describe why YOU would like to be included in one of HPP VIP Coaching Programs. Briefly describe why you feel you're a good candidate for the Mastermind HighValue Coaching Program:(attach additional sheet of information if necessary) Biggest Personal/ Business Challenges (Rank EACH 1-10,10 "Big", 1 "Teeny") Clarity of Goals & ObjectivesTurning an Ordinary Biz Into An Extraordinary BizSkills Better Than Present OpportunityTime Management & Personal ProductivityEmployeesFighting To Shed/ Transcend Limiting BeliefsConfidence &/or Strategies To Raise Prices/ FeesCompetition, CommoditizationFinances - (i.e., making but not keeping money)Leaping vs. Ladder-Climbing(I'm still ladder climbing)Still Heavily Influenced, Restricted By 'Norms'Other:___________________________Self-Assessment: Rank 1=Poor to 5=Damned Near Perfect Advertising, Marketing &Sales SkillsTime Allocated To Marketing & SalesAutonomy (Able To Do Business On Your Own Terms)Discretion In Selecting OpportunitiesTough-MindednessSatisfaction With Income & Income GrowthSatisfaction With Wealth & Wealth GrowthSatisfaction With Time Allocation To Biz, To PersonalAgility: Anticipation of change, active embrace of changeControl of Business & LifePeople You Associate WithPeople You Rely OnYear To Year Improvements, In TotoAbility To Influence OthersDO YOU REGULARLY OR FREGUENTLY USE: Direct-mailYesNoVoice BroadcastYesNoWeb SiteYesNoE-MailYesNoPrint Media Advertising, LocalYesNoRadio/ TV Advertising, LocalYesNoPublicity/ News Releases, LocalYesNoNewsletterYesNoPersonal NetworkingYesNoTele-MarketingYesNoOther (please specify) YOUR SCHEDULENumber of hours you work, average weekNo of hours you'd prefer to work, average work% of work-time you rank as productiveNo. of hours per week you work "on" vs. "in" your businessNo. of Weeks of vacation taken: 2016:2017:2018:No. of Weeks of vacation you'd prefer taking:High Performance Practice Coaching Mastermind Participation Agreement Terms & ConditionsOnce I am accepted into a program, I authorize to charge my card(s) as indicated in this application for membership in the Private Coaching & Mastermind Program. I understand and commit to working with total integrity, honesty and confidentiality with other members of this Special Coaching Group of like-minded top achievers. I understand and agree that, by completing and signing this enrollment form, if accepted into a program, I will have my credit card(s) charged (or check cashed) for the participation rates described on Page 4, 5 or 6 of this application based on my selected investment option for my inclusion in these private and exclusive programs.I understand and agree that if I miss any scheduled coaching calls with that I lose that call and cannot reschedule it. I also understand that any/ all one-day consulting days, scheduled coaching calls, emergency calls and mastermind meetings expire at the end of the twelve (12) month agreement and any of the above that are unused are lost and will not carry-over past at the end of the twelve (12) month agreement and end date. Further, I agree by signing this agreement for products/ services stated herein, I am solely and completely responsible for any indebtedness incurred, as a result of my entering into this agreement with HPP. Whether I assign my rights (i.e. deciding to partner with another individual) hereunder, or delegate my obligations under this agreement, I understand that I am responsible for the complete and total amount due to HPP.I understand and agree that by completing and signing this enrollment form that I am committing to a full twelve (12) month period in the program from the today's date as printed on page one (1) of this enrollment form. I further understand and agree that, if, for any reason, I choose to remove or cancel myself out of the program prior to the end of the twelve (12) month, program dates, I am obligated to pay or continue paying any outstanding balance(s) for the entire twelve (12) month period from the date printed on this enrollment form for any investment option I select. I understand this is a 12-month non-cancelable commitment and I understand the program details described in the letter which accompanied this agreement. Further, I fully understand and acknowledge that neither High Performance Practice, Limited Liability Company(HPP, LLC) or any representative of HPP,LLC., neither promises or guarantees any verbal or written results with relation to myself or my business and that all actions and results are up to me. I therefore hold harmless High Performance Practice, Limited Liability Company(HPP, LLC) or any representative from any / all claims that may rise from my participation in this program. High Performance Practice, Limited Liability Company(HPP, LLC) has sole discretion to terminate agreement and remove any participant from continuing in the program at any time without a refund if the participant is disrupting the program or is difficult to work with, becomes difficult to work with, or ceases to follow any of the coaching program guidelines. If done so, participant will no longer be charged the monthly rate if participant is on the monthly payment plan. Type Full NameDate