App - Dr. Dangerfield

Application For Acceptance

* Indicates required field

How much money do you want to make in the next twelve months? *

$45,000 - $75,000 $75,000 - $125,000 $125,000 - $200,000 $200,000 - $250,000 $250,000 - $500,000

If Other please specify: *

How many hours do you want to work per week? *

40+ 30-40 20-30 20-10 10 or less

How much time per day do you want to spend with your family and friends? *

10 minutes 45 minutes 2 hours 5 hours

How many vacations do you want to take each year? *

One Two Three Four

How many years until you want to retire? *

30 20 10 5

Why do you want Dr. Dangerfield to Mentor you through her PROVEN process? *

Name *

First

Last

Email *

Phone Number *

Best time to call *

Submit