Contact Details

Full Name

Your Title At Work

Organisation Name

Website

Country

Email *

Phone *

Organisation Profile

Which best describes your organisation?

Number of Employees

Approximate Annual Turnover

Looking Forward

Imagine we are celebrating together twelve months from today. What would have happened for you to say… “Working with Eryca has genuinely changed my life.”

What would you like your life to look like?

What are the three biggest changes you would like to achieve?

Your Readiness

On a scale of 1–10 please answer honestly. How ready are you to change your life?

How committed are you to doing the work required between sessions?

How open are you to honest feedback and being challenged respectfully?

If things become uncomfortable during your transformation, will you continue?

Working Together

Live Beyond 50 is a partnership. Please indicate whether you agree with the following statements. *

I understand meaningful transformation requires commitment.

I understand Eryca cannot change my life for me.

I understand I will be encouraged to take responsibility for my own progress.

I understand some conversations may challenge my current thinking.

I understand honesty is essential throughout the programme.

I understand that lasting change takes time.

Investment Readiness

Live Beyond 50 is an exclusive private transformation programme. Places are limited and every application is carefully reviewed. If we both agree that this programme is right for you, are you comfortable making a significant investment in your personal transformation?

If offered a place, when would you ideally like to begin?

Immediately

Within 30 days

Within 90 days

Later this year

Why Live Beyond 50?

Why have you chosen to apply to work specifically with Eryca Freemantle?

What do you believe I can help you achieve that you have not yet achieved on your own?

Is there anything else you would like me to know before reviewing your application?

Declaration

I confirm that the information I have provided is accurate to the best of my knowledge.

I understand that submitting this application does not guarantee acceptance onto the Live Beyond 50 Programme.

I understand that Eryca Freemantle Ltd carefully reviews every application to ensure the programme is the right fit for both parties.

I understand my information will be treated confidentially and processed in accordance with the Privacy Policy.

Signature *

Clear

Date *