Course Application

If you feel that you are ready to begin this life-changing process, please answer the questions below and submit the form.

Your answers to these questions are important because they help me to better tailor each class to the  individual needs of the participants. More importantly, they will begin the process of change within your own consciousness, so answer them as clearly and honestly as you can.

The path to discovering and living your own Brilliance begins the moment you commit to it!

Name:

Email:

Phone:

City:

State or Province:

Country:

If there were a secret passion in your life, something that is almost too exciting to actually do or do more of, what would it be?

What challenges repeatedly hold you back from performing at your highest potential?

How would your friends, family & co-workers describe you?

Think of a time when life was very inspiring for you. What caused you to feel fulfilled at that time?

What do you want to get out of the Bridges to Brilliance program?

What time of day would you prefer the class to be?

Time Converter

Additional comments:

Please enter the code that you see:
captcha