ACC Group Mentor Coaching Program Registration

Name *

First

Last

Email *

This is the email that all program correspondence and invoices will be sent to.

Your primary website or LinkedIn URL *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Where did you receive your coach training? *

Approximately how many hours of coaching have you logged? *

Your current ICF credential level: *

Your goal for the Group Mentor Coaching experience is: *

Which ACC credentialing path are you on? *

Which PCC credentialing path are you on? *

This registration is for the following ACC Mentor Coaching Program: *

Please indicate the Group Mentoring Program you participated in, including the dates.

When would you like to begin your 1:1 sessions?

What invoicing schedule would you prefer? *

At the program start for the full amount (program starts with your first 1:1 session or the first group session, whichever comes first)
In two equal payments (one at start, second around group session #3)
In three equal payments (due the first of the month over three consecutive months)
Other

What payment arrangement/schedule works for you? *

Did someone refer you to this program? If so, please let me know who so I can thank them!

Additional Comments or Questions

Please confirm you agree to the following; all are required. *

I commit to attending all group and/or individual scheduled sessions.
I will actively participate, support my coaching colleagues, take responsibility for my learning, communicate openly and honestly, and honor the group agreements established in the first session.
I understand my registration is not complete until I have paid my invoice and/or clarified and agreed to alternative payment arrangments or payment schedule (indicated in this form).
My program investment is non-refundable (exception: program cancellation).
I understand that participation does not guarantee that I will be awarded the credential I am seeking from the ICF.

Signature (initials are fine) *