What are you most interested in?

 

The following are a few question in order to help us better serve your interest. Please take the time to fill out the brief form.

Once you fill it out submit it and we will send you one of several FREE gifts that match your interests.

(Fields marked with * are required)

Personal Information

*Name:

*Email Address:

Phone Number:

*Address:

*City:

*State:

*Country:

*Zip Code:

 

Academic Information

*Current MasterMeditation™ Level (if you don't have a level yet, put "none"):

*MasterMeditation™ Level You Are Testing For:

 

Membership Information

*Subscribe me to the email newsletter:

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No

*I am interested workshops:

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Please answer all of the questions below:

 

1. Which program is your primary interest?

MasterMeditation

ActiveMeditation

Lotus Tai Chi

Relax and Recharge

 

2. Which program is your secondary interest?

MasterMeditation

ActiveMeditation

Lotus Tai Chi

Relax and Recharge

 

3. Which is your preferred venue for completing courses?

iPhone Application

Downloads

DVDs

Bay Area Courses and Workshops

Online Classes

 

4. How did you find out about Selfmastery™?

iTunes

Google Ads

Surfing the Web

Bay Area Ads

Someone told me

 

5. What do you want most?

Increase Mental Focus

Relieve Stress

Relieve Chronic Pain

Improve Memory

Enhance Confidence

Learn to Meditate

Develop a Meditation Program

 

6. Are you interested in getting certified?

Yes

No

 

7. Are you interested in learning to teach Selfmastery™ programs?

Yes

No

 

8. Are you interested in becoming an affiliate?

Yes

No