application

Full Name *

First Name

Last Name

Phone *

(###)

###

####

Birth Date *

MM

DD

YYYY

Do you understand that your time with Keith may result in potential blindspots being revealed. Are you ok with those areas being addressed? *

Yes I am ready, speak into any areas including blindspots.

I will allow blindspots to be spoken into. But It's not easy for me.

I'd prefer blindspot areas to not be spoken into.

How would you like to speak with Keith during these three months? *

In Person

On a phone call

On a zoom call

How did you hear about Keith? *

First Name

Last Name

If married, is your spouse in agreement with you receiving this type of input? *

Yes

No

I understand that my 3-month consulting fee of $25,000 is due before the first session of consulting begins. *

If your application is accepted, the full three-month consulting fee of $25,000 is due before the first of twelve one hour sessions begins. Do you understand that there is a no-return policy and once you have paid there are no refunds anytime during the consulting journey no matter what the reason?

Yes

12 Consecutive weeks

Do you understand that you are paying for 12 consecutive weeks of consulting with Keith Ferrante (Unless you come to another arrangement with Keith before this consulting journey starts.). If for some reason you are not able to meet for your session Keith is not responsible to make that session up with you at a later time. Are you ok with that?

Yes I understand and accept this policy.

Yes I understand this policy but would like to discuss my unique scheduling needs.

Liability

I understand that I am fully responsible for every decision I make as a result of my time with Keith. I will not hold Keith responsible for any information I choose to act upon. I take full responsibility for all my decisions as a result of my time with Keith and will not sue, or hold liable Keith Ferrante or any of his organizations.

Yes I take fully responsibility for any decisions I make as a result of my time with Keith and will not hold Keith responsible or liable. I freely make my own decisions.