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Coaching Intake Form
For members of the Working Writer Mastermind
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* Indicates required question
Email
*
Your email
Full Legal Name
*
Your answer
Pen Name(s) or Preferred Name
*
Your answer
Preferred Pronouns
Your answer
Were You Referred By One Of Our Coaches or Mastermind Members
*
Jeri Red Shepherd
Kim Rogne
Christopher D. Schmitz
AG Wedgeworth
TR Nickel
Other:
May I Contact You/Send Reminders Via . . . ? (Check All That Apply)
Phone (By Voice)
Text
Email
Please Share Your Socials - We Want To Follow Them All! (We've got all or most of them, so we encourage you to share as many as you have.)
Your answer
Street Address
*
Your answer
Apt, Unit, Suite
Your answer
City
Your answer
State
*
Your answer
Zip Code
*
Your answer
Preferred Phone Number
*
Your answer
Do you know other writers who could benefit from this program whose names and emails you are willing to share?
(You will receive a discount or gift for any fellow authors or writers who join based on your recommendation.)
Your answer
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