Ph: 540- 929-4703 6 Skype: 540- 322-1983 6 email@example.com 6 www.creationcoach.com
DAY PHONE: ______________________________
EVENING PHONE: __________________________
CELL PHONE: ______________________________
DATE OF BIRTH: ___/___/___
Payment can be made by credit card or personal check. Credit cards will be
charged before the first coaching session and then by the 1st of each month
thereafter. Personal check payments must be received by the 1st of each month.
Credit Card Option:
Name on credit card:______________________________________________________
Visa / MasterCard # ______________________________________ Exp.Date ___/___
Personal Check Option
Make check out to Doro Kiley in U.S. Dollars in the amount outlined in the Fee Plan
above. Check can be mailed to 9163 Sugar Run Rd. Copper Hill, VA 24079 prior to first
session of the month.
Duration of sessions: between 30 to 60 minutes; three times per month.
You, the Client, will call me, the Coach, at prearranged time for our scheduled sessions
at (540) 929-4703. You may also email me anytime [firstname.lastname@example.org] and I
will respond within forty-eight hours excluding weekends and holidays (or when I am
away on retreat).
- over –
Three scheduled meetings per
month between 30 and 60 minutes
each. In-between calls and emails
as needed but not necessary.
$275 per month payable at the
beginning of each month
1. CLIENT CALLS THE COACH AT THE SCHEDULED TIME AT (540) 929-4703
2. CLIENT PAYS COACHING FEES IN ADVANCE
3. CLIENT PAYS FOR LONG-DISTANCE CHARGES, IF ANY.
1. As a client, I understand and agree that I am fully responsible for my physical, mental
and emotional well-being during my coaching