Name *

First Name

Last Name

Phone Number

Optional but encouraged

(###)

###

####

What stage of life are you in? (Select all that apply) *

Married

Single

Father

Business Owner

Executive Team/Leader

In transition

Other

This experience includes physical challenges, honest reflection, and a willingness to learn/grow. Are you ready for that kind of experience? *

Yes, this is exactly what I need

i'm curious, but it makes me nervous (in a good way)

i'm not sure

Are you in a healthy place emotionally and relationally—or are you hoping this experience will “save” something? *

I’m in a healthy place and want to go deeper

I’m navigating some real challenges, but I’m stable and self-aware

I’m not in a great place right now and need an escape

To get the most out of this experience, you'll need to invest time. For learning, application of learning and sharing with the group. Are you willing and able to sign up for that? *

Yes

I'm not sure