Speed Seduction Elite Consult Application

Enter Your First Name *
Enter Your Last Name *
Enter Your E-Mail Address *
Enter Your Phone Number (include country code) *
Enter Your Skype ID (if you don't have one type "None") *
What is your occupation? *
What is your current income range? * $50K to $100K $100K to $250K $250k and up
Extremely Important Before You Book Your Session (Please Proceed If You Agree To The Following):
Please be aware that Ross Jeffries does not offer, nor does he practice psychotherapy. Should he take you on as a client, he does so as a coach and guide, not therapist. * Yes, I Understand And Agree, And I'm Ready To Get Started!
Your confidentiality is fully protected! All of the information in your application and all information in subsequent communications with me will be held and kept in the strictest confidence. * Yes, I Understand And Agree, And I'm Ready To Get Started!