<div class="mc-wrap"> <style type="text/css"> .mc-webform p { margin:0; padding:0; } .mc-webform-overlay { top:0; left:0; width: 100%; height: 100%; position: fixed; background-color: #000; opacity: .75; filter: alpha(opacity=75); -ms-filter: 'progid:DXImageTransform.Microsoft.Alpha(Opacity=75)'; filter: progid:DXImageTransform.Microsoft.Alpha(Opacity=75); z-index: 9999; } .mc-webform-popup { position: absolute; top: 50px; left: 50%; z-index:10000; } .mc-webform-popup .mc-btn-dimiss { cursor:pointer; position:absolute; top:-15px; right:-15px; } .mc-webform { font-family: 'Trebuchet MS', arial, sans-serif; font-size: 14px; line-height: 120%; outline:0; } .mc-webform .mc-section-messages { margin: 5px 0; padding: 5px 0; list-style-position:inside; font-size: 12px; } .mc-webform .mc-section-messages li { padding-left:10px; } .mc-webform a { color: #6893b9; } .mc-webform .mc-section-header, .mc-webform .mc-section-footer { padding:14px; } .mc-webform .mc-section-body-top, .mc-webform .mc-section-body-bottom { padding: 0 25px; } .mc-webform .mc-webform-item { margin-bottom: 3px; padding: 7px 25px } .mc-webform .mc-field-caption { display: inline-block; margin-bottom: 5px; } .mc-webform input[type="text"] { width:100%; padding: 5px 0; text-indent: 5px; border: 1px solid #ccc; } .mc-webform textarea, .mc-webform select { width: 100%; padding: 5px 0; border: 1px solid #ccc; } .mc-webform textarea { height: 75px; } .mc-webform .mc-required-explanation, .mc-webform .mc-section-privacy { font-size: 11px; } .mc-webform .mc-action-container { margin-bottom: 0; padding-top: 0; padding-bottom: 0} .mc-webform .mc-action-container button { width: 100%; padding: 10px; cursor: pointer; } .mc-webform .mc-section-body { padding-top:10px;padding-bottom:10px; } .mc-webform .mc-section-body-top { margin-bottom:10px; } .mc-webform .mc-section-body-bottom { margin-top:10px; } .mc-webform .mc-field-required-decorator { color:#FF0000; } .mc-webform .mc-field-required { font-weight:bold; } .mc-webform .mc-field-invalid { border-color:#FF0000;border-width:1px;border-style:solid; } .mc-webform .mc-section-messages { background-color:#FFFFFF;border-color:#FF0000;border-width:1px;border-style:solid;color:#FF0000; } .mc-webform .mc-hidden { display:none; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 { width:500px; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-section-header { background-color:#ececec;border-color:#e5e5e5;border-width:1px;border-style:solid;color:#666666; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-section-footer { background-color:#ececec;border-color:#e5e5e5;border-width:1px;border-style:solid;color:#666666; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-section-body { background-color:#f5f5f5;border-color:#e5e5e5;border-width:1px;border-style:solid;color:#333333; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-field-caption,.mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-field-option { color:#333333;font-family:"Trebuchet MS"; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-action-container button { color:#0717f5;background-color:#0afa3a;border-color:#6893b9;border-width:1px;border-style:solid; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-action-container { text-align:center; } .mc-webform-2e0b9bab-e295-4973-a160-54dac957b149 .mc-section-privacy { text-align:center; } </style> <form class="mc-webform mc-webform-2e0b9bab-e295-4973-a160-54dac957b149" method="post" action="https://www.mcssl.com/WebForms/Processor.ashx?wid=2e0b9bab-e295-4973-a160-54dac957b149" data-mc-wid="2e0b9bab-e295-4973-a160-54dac957b149" data-mc-required="mc-firstname,mc-lastname,email1,mc-email2,address1,city,state,zip,country,coachingA,coaching1,coaching2,coaching3,coaching4,coaching6,coaching5,coaching14,coaching8,coaching9,coaching10,coaching11,coaching12,coaching13,coaching15,coaching16,coaching17" data-mc-format-email="email1,mc-email2" data-mc-compare-fields="mc-email2:email1"> <div class="mc-content-wrap"> <div class="mc-section-header"> <h1 data-mce-style="text-align: center;" style="text-align: center;"><span style="font-family: "arial black", "avant garde";"><strong><span style="line-height: 115%; font-size: medium;" data-mce-style="line-height: 115%; font-size: medium;">COACHING APPLICATION</span></strong></span></h1> </div> <div class="mc-section-body"> <div class="mc-section-body-top"> <p style="text-align: left;" data-mce-style="text-align: left;"><span style="font-size: small; line-height: 115%; font-family: trebuchet ms,geneva;" data-mce-style="font-size: small; line-height: 115%; font-family: trebuchet ms,geneva;"><br></span></p> </div> <ul class="mc-section-messages mc-hidden"></ul> <div class="mc-webform-item"> <label class="mc-field-caption">First Name</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="mc-firstname" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Last Name</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="mc-lastname" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Email</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="email1" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Confirm Email</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="mc-email2" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Address1</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="address1" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Address2</label> <div class="mc-field-item"> <input type="text" name="address2" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">City</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="city" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">State</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="state" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Zip</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="zip" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Country</label><span class="mc-field-required-decorator"> *</span> <div class="mc-field-item"> <input type="text" name="country" /> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Have you ever applied to Brad's coaching program before?</label><span class="mc-field-required-decorator"> *</span> <div> <select name="coachingA"> <option value="">-- Select --</option> <option value="163628" selected="selected">Select One</option> <option value="163629">Yes</option> <option value="163766">No</option> </select> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Why do you want to change or improve now?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching1"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Why are you seeking change now?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching2"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption"> How will you know when you have achievd what you want?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching3"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What in your current situation upsets you the most? How do you know your upset?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching4"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption"> Are you able & willing to reinvest $300-$500 per month back into your business to take you to the next level & create the business of your dreams?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching6"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What is most important to you in your life and how do you know that?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching5"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What is holding you back? (recurring problems, limiting beliefs, unproductive habits, etc?):</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching14"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What are your primary business/professional goals?:</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching8"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">List five goals you have currently (Now Vision):</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching9"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">List five goals you want to accomplish within the next 12 months (Near Vision):</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching10"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">List five goals you want to accomplish in your lifetime (Far Vision):</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching11"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What are you willing to do to achieve your goals? [Don't say whatever it takes - be specific, please]:</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching12"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What are your professional strengths and assets?</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching13"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">What accomplishments are you are most proud of in your life and why?:</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching15"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">If you are accepted as a client, what do you most want to get out of our coaching relationship?:</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching16"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">How would you know if you are getting it?:</label><span class="mc-field-required-decorator"> *</span> <div> <textarea name="coaching17"></textarea> </div> </div> <div class="mc-webform-item"> <label class="mc-field-caption">Comments/Questions - Please share any comments, questions, thoughts or concerns that Brad should know about while reviewing your application.</label> <div> <textarea name="coaching18"></textarea> </div> </div> <div class="mc-webform-item mc-required-explanation"> <label><span class="mc-field-required-decorator">*</span> Required Fields</label> </div> <div class="mc-webform-item mc-action-container"> <button type="submit"> <p style="text-align: center;"><span style="font-size: small;"><strong><span style="font-family: 'trebuchet ms', geneva;">Submit</span></strong></span></p> </button> </div> <div class="mc-section-body-bottom"> <p><br></p> </div> </div> </div> </form> <script src="https://www.mcssl.com/WebForms/scripts/mc-webforms.full.js?t=1" type="text/javascript"></script> <script type="text/javascript"> var _wfq = _wfq || []; _wfq.push(["__initEmbeddedForm", "2e0b9bab-e295-4973-a160-54dac957b149", { "trackUrl": "https://www.mcssl.com/WebForms/beacon.ashx?wid=2e0b9bab-e295-4973-a160-54dac957b149" }]); </script> </div>