Celebrity Experience with Melissa Kathryn

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out this application below, it’s important for me to get to know a little about you before we discuss the next steps. If you are one of the women selected to join this round and your application has been approved, you will receive an email with details, dates and what to expect in our time together.

Email *

Full Name (First and Last) *

Phone *

A little about you - why are you interested in the Whole Package: Celebrity Experience with Melissa Kathryn? *

Where in life does a lack of Wholeness keep you from having what you want? *

Tell me about your strengths. What do you like best about yourself? *

Tell me about your habits. What habit(s) would you like to break? Why?
*

What habit(s) would you like to start? Why?
*

Tell me about your challenges. Where are you currently struggling?
*

Tell me about your history. How does your history with mental health, physical health, trauma, and/or addiction affect your happiness and life’s goals currently?
*

Tell me about your commitment level. If accepted are you 100% a HELL YES?
*

Tell me about your desires. What measurable successful outcome would you like to get from our work together? What goals do you want to cover in our time together?
*

Tell me anything. What else would you like me to know?
*

Thanks for applying to spend the weekend with me!

We'll review and be in touch soon <3

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Melissa Kathryn Makeover. Report Abuse

Forms