Reborn Application Form

Reborn is NOT for the average man.

This is an INVITE ONLY quantum activation program & brotherhood for your entire life as a man.

We only work with perfect fit clients to maintain the near perfect success rate in our programs, therefore, it's important that you take the time to answer the questions thoughtfully and in as much detail as possible so we get a clear sense of where you're at and if you're a good fit.

Once you apply, your application will be reviewed to make sure it’s a fit.

After reviewing your application, If we deem you ready for this level of activation, you will get a decision and next steps 24 - 48 hrs after you’ve submitted your application.

We help very specific types of men who have experienced at least 3 of the following situations. Select all that best apply to you. *

You are extremely ambitious and driven. You know that there's more to your life both professionally and in relationships with woman.

You have tried other modalities that haven’t fully worked (books, coaches, therapy, plant medicines and other such modalities)

You've noticed a repeated a pattern with finances and woman / relationships in your life.

Are an entrepreneur or professional in one of these fields: Real Estate, Doctor, Finance, Architect, Music Producer, Attorney, Exec at a company or Consultant / Coach OR have achieved some level of material success in your field of expertise.

Reborn has an excellent success rate because we only accept men who are ready for change. Are you willing to (select all that apply to you).

Be spiritually open-minded

Leave your ego at the door

Commit fully to do the work

Try a radical path

Fully welcome being challenged in all areas

Ready to embrace the dark and light aspects of yourself

Join and contribute to brotherhood of other successful men

What motivated you to apply for Reborn? *

Why are you filling out this application?

If you could solve ALL these challenges over the next 90 days, what would it mean for your life? *

Imagine a future where these challenges didn't exist, what would that mean for you?

Why is now the right time for this? *

Why not wait 6 months or a year? How does it make sense for you to be doing this work right now in your life?

Email *

First Name *

Last Name *

Phone *

Instagram Handle

Optional

What is your current level of annual earnings in USD? *It's important that we understand which level of earning you are at so we can provide the ideal solution that's calibrated to men at your level.

Joining Reborn requires a minimum investment of $5k USD. If it’s an absolute yes for both of us, are you ready to invest emotionally, energetically, and financially in yourself? *

Yes, I would be willing to invest if it’s an absolute yes

No, I’m opposed to investing in myself at these levels

Do you have any questions about joining Reborn?