Please take a moment right now to complete this short
LOVE BREAKTHROUGH SESSION APPLICATION
We ask that you please fill out this application so we can be sure you're a great fit for one of our sessions
.
We look forward to connecting with you!
settings
settings
settings
settings
Select...
United States
Canada
United Kingdom
Afghanistan
Åland
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
British Virgin Islands
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Cook Islands
Costa Rica
Croatia (Local Name: Hrvatska)
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Ivory Coast
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia (Slovak Republic)
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
São Tomé and Príncipe
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
U.S. Minor Outlying Islands
U.S. Virgin Islands
Uganda
Ukraine
United Arab Emirates
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
What country do you live in?
settings
What’s your best phone number?
settings
settings
Select...
Single
In a relationship that I should probably leave
Married or in a serious relationship and I want to stay together
What is your current relationship status?
settings
Select...
I want to get into a great relationship
I want to get married and/or have kids
I want to heal my attachment style and feel like my best self
I want to know if I should leave my current partner
What is your main goal for working together?
settings
What is going on in your love life that had you reach out for support?
settings
Select...
Do it, because I'm ready and I have the time.
Make the space because this is a priority for me.
I don't have the time and I'm too busy right now.
If someone told me to spend several hours a week, for several months taking specific actions that would help me heal my attachment style and call in the best relationship of my life, I would...
settings
Select...
I'm ready to transform my love life once and for all, and I have the financial resources to get started now.
I want to heal and find my partner, and can get access to financial resources to get started now.
I’m not open to investing financial resources because I don’t have access to them, and I would like to receive free resources that I can get started with now.
Right now...
settings
What is your career / profession or, if you're not currently working, what do you love to do most?
settings
If your application is accepted, one of our coaches will call you at the date & time selected. Our time and your time are valuable and we request that you commit to your appointment by typing this sentence in the box below – "
I promise to show up and be in a quiet place, near my computer, for a full hour, during my breakthrough session.
"
settings
Submit My Application
If you experience any technical difficulty submitting this application please contact support@empowerlove.us.
[bot_catcher]
