Member Info – North Texas Firewalkers

Number of Memberships *

Name *

First

Last

Name #2 *

First

Last

Email *

Name #3 *

First

Last

Cell Phone (Text Message reminders) *

For multiple memberships specify each member.

1. Self development events you have attended. *

2. Favorite speakers, authors, coaches etc. *

3. What material are you currently working on? What events are you planning on attending this year?

4. What are some changes you have made in your life? *

5. What are some changes you are currently working on? *

6. Do you have a morning ritual? *

Briefly describe your morning ritual. *

7. What are you looking for in a peer group? How we can add value to your life? *

8. How can you add value to the group? *

9. We believe in being a force for good. Are you interested in charity work? *

10. Topics of interest (select all that apply) *

11. Any additional topics that would interest you. *