Monthly Group Mentor Coaching - Multiple Month Registration

Name *

First

Last

Email *

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

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Where and when did you receive your coach training? (If currently in training, list your program) *

Approximately how many hours of coaching have you logged? *

Your current ICF credential level: *

None: currently in training, recently completed training, or in the process of applying
ACC
PCC
None: not pursuing credential

Your goal for the Group Mentor Coaching experience is: *

When does your credential expire?

My program choice *

Please contact me, I'd like to schedule one or more 1:1 mentoring sessions ($225/60min session. A scheduling link will be sent upon registration)

I'd like to register for the following months' Group session(s):

Check all that apply. Preparatory information and the Zoom link will be provided no less than one week before the scheduled session.

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 confidentiality and the group agreements established in the session.
I understand my registration is not complete until I have paid my invoice (sent via Square to the email you provided above)
My program investment is non-refundable (exception: program cancellation).
If I'm applying for or renewing a credential, I understand that up to 7 hours of group mentoring can be applied to the 10 hours required by ICF
If I'm applying for a credential, I understand that participation does not guarantee that I will be awarded the credential I am seeking from the ICF.

Signature (initials are fine) *

Monthly Group Mentor Coaching – Multiple Month Registration