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Who Do You Want To Be?
Coaching with The Empowerment Dynamic
Complete Your Application
First Name
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Last Name
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Street Address
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Address Line 2
City
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State/Province/Region
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Zip/Postal Code
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Phone Number
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Country
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Time Zone
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Email Address
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Company Name
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Work Title
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How did you hear about the coaching course? If referred by someone, please write their full name.
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What inspires you about this work for yourself, for your clients?
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What burden or reactive habit are you carrying that you are ready to set down, even if you aren’t sure how?
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Experience
What is your field of work?
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Coach
Trainer
HR
OD
Therapist/Counselor
Other
Other
Are you applying for ICF continuing education credits?
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No
What is your depth of experience with TED* and the 3VQ frameworks? Check all that apply:
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Receive the weekly essay
Read the book(s)
Attended a live/virtual workshop
Attended a previous webinar
Completed the eCourse
Are a Certified 3VQ Trainer
No previous experience, looking to learn more
Desired Outcomes
What attracted you to this course?
What are you looking to take away from this course?
Do we have your permission to share your contact information with other members of the class? (Your street address will not be shared.)
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Yes
No
We will not, in any circumstances, share your personal information with other individuals or organizations without your permission.
Payment
After submitting your registration, please allow ample time for us to email you with the next steps. Invoices will be sent via PayPal (from Bainbridge Leadership Center) where you will have the option to pay by card or with a PayPal account.
Select Payment Option
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One-Time Payment ($1,450.00)
Payment Plan (4 payments of $375.00)
Agreement
Unless extenuating circumstances arise, I can commit to attend the live sessions on Tuesdays from 8:30-10:00am Pacific Time as well as participate in a pod that will meet on a weekly basis outside the scheduled live sessions.
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Yes
No
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