Leading Edge Group Mentor Coaching 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 Leading Edge Mentor Coaching Program: *

“FULL” includes three 1:1 mentor coaching sessions. Additional 1:1 sessions are available to both FULL (and GROUP) registrants for $200/session.

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

What invoicing schedule would you prefer? There is no additional charge for installment plans. *

At the program start for the full amount (“program start” = your first 1:1 session or the first group session, whichever comes first)
In two installments (1st of Jan and July)
In quarterly installments(1st of Jan, April, July, Oct)
12 monthly installments (1st of the month)
12 monthly installments(15th of the month)
Other

Invoices are managed through Square and are scheduled according to your preferences. Payment is accepted via check or credit/debit card.

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 as indicated in this registration 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 (if applicable).

Signature (initials are fine) *