First Name *

Last Name *

Phone *

Email *

What are your preferred pronouns? *

She/Her

He/Him

They/Them

N/D

I agree to terms & conditions provided by Meshell Baker LLC. By providing my email and phone number, I agree to receive email and text messages from Meshell Baker LLC.

Background Information

What is your age range? *

19-29
30-39
40-49
50-59
60-69
70+
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What is your educational background? *

High School
2 Years College
4 Years College
Graduate Degree
Terminal Degree
Other
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If you chose Other for educational background, please explain here.

Are you currently participating in any coaching or training programs? *

Yes

What do you consider to be your three strongest personal character traits at this time? *

What do you consider to be your three personal weaknesses at this time? *

Do you acknowledge? *

Yes, I acknowledge Meshell will help guide and direct me and I understand that I am responsible for my own transformation. Results are directly correlated to Members commitment and participation.

Mailing Address

Address *

City *

State *

Postal code *

Country *

Country

Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, The Democratic Republic of the
Cook Islands
Costa Rica
Cote D"Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic Of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People"S Republic
Korea, Republic of
Kuwait
Kyrgyzstan
Land Islands
Lao People"S Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, The Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
UK
Ukraine
United Arab Emirates
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Confidence & Intentions

What is your intention for joining The CRAZY Confidence Collective at this time? (Choose as many as you like) *

To build my unstoppable confidence

To create a clear and compelling vision

I like the way Meshell teaches

Sounds inspiring/empowering

To enhance my career opportunities

Other

If you chose Other for your intention, please explain here.

Please indicate on a scale of 1 to 5 your current level of confidence. *

1 😩 Shaky

2 😩 Sometimes

3 😊 Stable

4 😊 Strong

5 🤩 Unshakeable

Which of the following is a challenge for you at this time? (Choose as many as you like) *

Being open to new ideas
Being Critical (Of Self or Others)
Receiving Feedback
Giving Feedback
Complaining
Finishing what I start
Making Decisions/Choices
Asking for what I need
Receiving/Asking for help/support
Sharing my thoughts/feelings
Disappointing others/People Pleasing
Working in groups
Consistent Action/Activity
Time Management
Managing Emotions/Emotional Management
Unforgiveness
Loneliness
Sadness/Depression
Anxiety
Other
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If you selected Other as a challenge, please explain here.

Using a maximum of 100 words, what would you like to gain from your participation in this coaching program?

Your Commitment

The CRAZY Confidence Collective will require a approximately of 15 to 20 minutes a day and access to 60 minute weekly live interactive training and Q&A calls. Is this a commitment you are ready and willing to make at this time. *

Yes

I can't right now.

I will think about it.

Participation in The CRAZY Confidence Collective requires a monthly financial investment of $147.00. Is this a commitment you are able and willing to make at this time? *

Yes

I can't right now.

I will think about it.

To participate in The CRAZY Confidence Collective, you will need to have access to Zoom for our weekly coaching calls and you are required to turn on your camera during the meetings. Is this a commitment you are willing to make? *

Yes

And Finally

How did you hear about The CRAZY Confidence Collective with Meshell Baker.

Referral

Speaking Event

Social Media

Website

Your application is the opportunity to determine whether you and the small group of women gathering are a great fit for one other. The application will take approximately 3-5 minutes.