Registration

One Year Challenge Registration

Please complete the form below for entrance into the One Year Challenge!
Required fields are noted with an asterisk (*).

*First Name

*Last Name

*Age

* Mailing Address

*City

*State

*Postal Code

*Phone Number

*Email Address

*Please state your major goal for the coming year (Be as specific as possible):

*Please explain why this goal is important to you and how will it change your life?

*What obstacles do you expect to face as you pursue your goal?

*List the activities you will complete to achieve this goal

*What end results do you want to achieve in the next twelve months to accomplish this goal:

What success traits or principles outlined in this book will you use to reach your goal?