Signature Program Registration

1. Registrant Information

Email

First name

Last name

Common name

Birthday

Phone number

Mobile number

Business name

Type of business

2. Billing Information

First Name

Last Name

Email

Phone

Street address

Unit / Apt / Suite

City

Country

State / Province / Region

Zip / Postal code

Shipping Address

Where should we ship your program materials?

Same as Billing Address

First Name

Last Name

Email

Phone

Street address

Unit / Apt / Suite

City

Country

State / Province / Region

Zip / Postal code

3. Additional Information

I certify that my personal income from entrepreneurial activities is:

Between $200,000 - $500,000

$500,000 to $1,000,000

More than $1 Million

Is there someone specific that referred you to us? If so, please provide their name(s):

Please list any professional/trade associations to which you belong, if any.

Name of Assistant or Key Administrative Staff:

Email Address (Assistant)

Phone/Extension (Assistant)

Please inform us in advance of any specific dietary needs you may have:

4. Payment & Terms

Payment Details

Deposit Due Today:
$2,500.00

Balance Due: Wednesday March 24, 2027)
$12,500.00

Total Program Fee: $15,000.00

Terms & Authorization

By signing up as a Strategic Coach® client, you certify that you have read and agreed to Strategic Coach’s Privacy Policy and Terms & Conditions, and you understand that your acceptance and participation in the Strategic Coach® Program is dependent upon a Right-Fit conversation with a Membership Advisor and verification of your qualifying entrepreneurial income level. You also understand that:

the balance of your annual fee is due three weeks prior to the date of the first session, and if you register for the Program within three weeks of the first session, the full annual fee amount is due at the time of registration; and
your deposit is non-refundable or transferable; and
once you attend the first session, none of the annual fee is refundable or transferable, and there is no credit for missed sessions; and
Strategic Coach may contact me, electronically or otherwise, regarding my progress in the Program or to let me know about new products, services, and features offered by Strategic Coach.

Authorize Deposit Charge
I hereby authorize The Strategic Coach Inc./The Strategic Coach USA Inc. to charge the credit card account number on this form for the deposit amount of $2,500.00.

Authorize Balance Charge
I authorize The Strategic Coach Inc./The Strategic Coach USA Inc. to charge the balance on the full investment amount three weeks prior to the start date using the above credit card.

Accept Terms & Conditions
I agree to the Terms & Conditions.

SMS Messaging (Optional)
I agree to receive text messages from Strategic Coach. Message and data rates may apply. Message frequency varies. Reply STOP to cancel.

By saving this card you authorize The Strategic Coach Inc. to charge it for the outstanding balance and any future amounts due on this account, on the schedule described in your agreement. You can change or remove this card at any time in your account settings.

Credit Card form will appear once you've agreed to the Terms & Conditions.
Your payment information is securely processed by Stripe. We never store your full card details.

Workshop Schedule

First Session

Location

Upcoming Session Dates

Payment Summary

Shipping Address

Payment Details

Terms & Authorization