First Name *

Last Name *

Phone *

Email *

Your 2-minute introduction video — one take, no script. Please cover: (1) who you are and what you do now, (2) why NeuroElites and who you most want to help, (3) where you honestly are with your own health, (4) how you think about the responsibility of a powerful system. *

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Country / time zone *

Professional background *

How long have you worked in this field? *

What have you already tried — for yourself or your clients — that hasn't fully worked?

How ready are you to commit to the full programme (pre-course sessions, live training, and post-course sessions)? *

Fully ready — this is a priority for me

Ready, with some scheduling to arrange

Interested, but not sure I can commit yet

The Foundation is a premium programme (approximately $15,000 + VAT). If you are accepted, are you in a position to invest? *

Yes — I'm ready to invest if accepted

Yes — with a little planning

Not at this stage

Once you have learned NeuroElites, what would you do with it? *

Is there anything else you'd like us to know?

Selective programme consent

I understand this is a selective programme and not everyone is admitted.

Code of Conduct consent *

I understand that, if accepted, access is conditional on signing and following the NeuroElites Code of Conduct, and that practising outside those terms ends my association with NeuroElites.