Coaching Sessions Get Your Coaching Started Today! Coaching Enrollment & Payment Signup: Please Provide Your Personal Information:(Required) First Last Email PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code STEP 1: Select Your Coaching Package(Required) 3 Month Package 6 Month Package 12 Month Package 24 Month Package Total Due Today: 3 Month Coaching Package Fee:(Required)Pay in fullSplit my payment6 Month Coaching Package Fee:(Required)Pay in fullSplit my payment12 Month Coaching Package Fee:(Required)Pay in fullSplit my payment24 Month Coaching Package Fee:(Required)Pay in fullSplit my paymentTerms of Split Payment Agreement I agree to the "Split My Payment" agreement.By selecting "Slit my payment" you agree to pay the 50% deposit of your coaching package fee today and any remaining balance of the coaching package fee no later than 30 days after coaching begins.STEP 2: Review the Coaching Agreement Terms(Required) I agree to the terms of the Coaching Agreement below:1. Coach and Client will meet twice monthly at an agreed upon time and place. Each session will be a person-to-person session through out the duration of the coaching term. Any changes to a coaching session will be agreed to by both parties, in writing, 48 hours prior to any agreed upon sessions. 2. Coach and Client agree to jointly develop a future action plan based on the Client’s in- tended outcomes and committed actions throughout the entire coaching process. 3. Coach agrees to facilitate as per agreement and Client agrees to follow the coaching recommendations and execute all tasks given during the term of coaching program. All agreements to be negotiated and agreed upon by both coach and client at the time of each Coaching Session throughout this agreement. 4. Coach agrees to prepare for each session reviewing any and all pre session forms while client agrees to complete any and all pre session forms 24 hours prior to the scheduled session time. 5. Client understands any results from coaching depend on his/her ability to take action and follow the coaching plan to the best of his/her abilities. Client will clearly communi- cate all concerns with your Coach, and accept personal responsibility for the results you achieve. The responsibility for taking action and following through with each task is the clients alone. 6. Client agrees to share with Coach specific issues on which Client desires assistance. Client agrees that issues not shared with Coach may not be resolved or may impede the successful achievement of his/her goals and objectives. Coach agrees to use best efforts to assist Client to resolve issues shared with Coach and also agrees to full confidentiality. 7. Client agrees that Coach may assign tasks following or during any Executive Coaching Session and Client agrees to complete and report on all outcomes to coach at time of follow up on agreed upon times. Client further agrees that if ALL TASKS are not com- pleted in full as agreed upon by coach and client then the outcome of the coaching cannot be predicted or guaranteed. 8. Client understands that Coach is not providing psychological or medical advice and that Coaching will in no way replace sound treatment from a licensed health care provider. Your Coach is not a licensed Medical Doctor, Psychologist, Psychiatrist, Master’s in Family Therapy (MFT), or a Master’s in Social Work (MSW). The services you receive are not licensed in this state, nor are they regulated by a governmental body. Your coach will always provide only those services in which the coach has been trained, and if the coach finds at any time that he/she cannot help you, the coach will refer you to a li- censed person who can. Signature:(Required)*NOTE: By typing your name you fully acknowledge and agree to the terms of the above Coaching Agreement.Date(Required)Agreed to on: DD slash MM slash YYYY STEP 3: Make Your Payment Cardholder Name Card Details CAPTCHA Δ Miles Rubin Executive Coach