Fill Out This Application To See If You Qualify

Name *

Email Address *

Phone Number *

Skype ID (Session will be conducted via Skype Call - audio only)

City/Country *

Profession *

How important to you is getting this part of your life handled? *

Extremely Important

Somewhat Important

Just Thinking About It

How serious are you about getting 1-ON-1 coaching? *

I know I need a personal coach

I am also considering group coaching

Not sure yet if live coaching is right for me

Approximately how many dates do you go on per month? *

What is your biggest challenge and/or fear when it comes to women and dating? *

What are the 3 most important goals you would like to accomplish during your coaching program with The Attractive Man and why? *

Have you taken any other course, bootcamp or seminar in the field of dating/self-improvement/pickup? If so, who was it with and what was your biggest takeaway (and/or biggest disappointment)? *