Self Made

VIP

Application

Thank you for your interest in Self Made VIP!

As a reminder, Self Made VIP gives you EVERYTHING included in Self Made PLUS exclusive coaching with Bonnie Lefrak.

Please note that Self Made VIP has limited spots available. If you are accepted to the program, you will be expected to complete your purchase and begin within 48 hours of acceptance.

Please complete the form below to apply.

Name *

First

Last

Email *

Your best email so we can send you the zoom link

Phone *

Your cell in case we don't receive email confirmation

How did you hear about Bonnie Lefrak and the Self Made VIP Program? *

Age *

What is your current weight and height? *

What is your goal weight? *

What are your goals beyond the scale? *

Why is NOW the time you have decided to get started? *

What kinds of diets or workouts have you tried to reach your goals in the past? *

If you were to be 100% honest - what do you think is stopping you from hitting your desired goals? *

Anything else we should know?

I understand that I am required to check in with Bonnie each week. Are you willing to participate in weekly check-ins? *

Yes
No

IMPORTANT: If you're accepted to work with Bonnie you will be expected to complete your $3,997 program purchase and begin within 48 hours of acceptance. Please confirm "YES" below that you understand this policy. *

Yes
No, I am not ready at this time.

Name